Replication defective adenovirus vector in vaccination

ABSTRACT

Methods for generating immune responses using adenovirus vectors that allow multiple vaccinations with the same adenovirus vector and vaccinations in individuals with preexisting immunity to adenovirus are provided.

CROSS-REFERENCE

This application is a National Stage of International Application No. PCT/US2013/032688, filed Mar. 15, 2013, which claims priority to U.S. Provisional Application No. 61/693,187, filed Aug. 24, 2012, 61/694,013, filed Aug. 28, 2012, 61/748,494, filed Jan. 3, 2013, and 61/756,870, filed Jan. 25, 2013, each of which applications are hereby incorporated by reference in their entirety.

STATEMENT AS TO FEDERALLY SPONSORED RESEARCH

This invention was made with government support under Contract No. HHSN 261200900059C, awarded by the National Cancer Institute; and Contract No. HHSN 261201100097C, awarded by the National Cancer Institute; Grant No. 1R43CA134063, awarded by the National Cancer Institute; Grant No. 2R44CA134063 awarded by the National Cancer Institute; and Contract No. HHSN 261200900059C, awarded by the National Cancer Institute; and Contract No. HHSN 261201100097C, awarded by the National Cancer Institute. The government has certain rights in the invention.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has been submitted in ASCII format via EFS-Web and is hereby incorporated by reference in its entirety. Said ASCII copy, created on May 29, 2015 is named 38981-710-831 SL.txt and is 48 Kilobytes in size.

BACKGROUND

Cancer immunotherapy achieved by delivering tumor-associated antigens (TAA) has recently demonstrated survival benefits; however limitations to these strategies exist and more immunologically potent vaccines are needed. To address the low immunogenicity of self-tumor antigens, a variety of advanced, multi-component vaccination strategies including co-administration of adjuvants and immune stimulating cytokines have been employed. Alternatives include the use of recombinant viral vectors that inherently provide innate pro-inflammatory signals, while simultaneously engineered to express the antigen of interest. Of particular interest are adenovirus serotype-5 (Ad5)-based immunotherapeutics that have been repeatedly used in humans to induce robust T cell-mediated immune (CMI) responses, all while maintaining an extensive safety profile. In addition, Ad5 vectors can be reliably manufactured in large quantities and are stable for storage and delivery for outpatient administration. Nonetheless, a major obstacle to the use of first generation (E1-deleted) Ad5-based vectors is the high frequency of pre-existing anti-adenovirus type 5 neutralizing antibodies. These antibodies can be present in a potential vaccinee due to either prior wild type adenovirus infection and/or induction of adenovirus neutralizing antibodies by repeated injections with Ad5-based vaccines, each resulting in inadequate immune stimulation against the target TAA.

A major problem with adenovirus vectors has been their inability to sustain long-term transgene expression due largely to the host immune response that eliminates the adenovirus vector and virally transduced cells in immune-competent subjects. Thus, the use of First Generation adenovirus vector vaccines is severely limited by preexisting or induced immunity of vaccines to adenovirus (Ad) (Yang, et al. J Virol 77/799-803 (2003); Casimiro, et al. J Virol 77/6305-6313 (2003)). One group reported that a preponderance of humans have antibody against adenovirus type 5 (Ad5), the most widely used serotype for gene transfer vectors, and that two-thirds of humans studied have lympho-proliferative responses against Ad (Chirmule, et al. Gene Ther 6/1574-1583 (1999)). In another study, an adenovirus vector vaccine carrying an HIV-1 envelope gene was incapable of reimmunizing a primed immune response using non-adjuvanted DNA (Barouch, et al. J. Virol 77/8729-8735 (2003)). Another group reported that non-human primates having pre-existing immunity against Ad5 due to a single immunization with Ad5 were unable to generate transgene-specific antibodies to HIV proteins, as well as altering the overall T cell responses (McCoy, et al. J. Virol 81/6594-6604 (2007)).

There are numerous mechanisms by which preexisting immunity interferes with adenovirus vector vaccines but one major concern is the presence of neutralizing antibody followed by cell mediated immune elimination of Ad infected antigen harboring cells. Both of these responses can be directed to several Ad proteins. One approach is to increase the vector vaccine dose. Although there is evidence that increasing vaccine doses can increase induction of desired cell mediated immune (CMI) responses in Ad-immune animals (Barouch, et al. J. Virol 77/8729-8735 (2003)), it often results in unacceptable adverse effects in animals and humans. When using First Generation Ad5 vector vaccines, one option can be to use the approach of a heterologous prime-boost regimen, using naked (non-vectored) DNA as the priming vaccination, followed by an Ad5 vector immunization. This protocol may result in a subsequent immune response against Ad5 such that one cannot administer a further re-immunization (boost) with the same (or a different) adenovirus vector vaccine that utilizes the same viral backbone. Therefore, with the current First Generation of Ad5 vectors, using this approach can also abrogate any further use of Ad5 vector immunization in the Ad5 immunized vaccinee.

First Generation (E1 deleted) adenovirus vector vaccines express Ad late genes, albeit at a decreased level and over a longer time period than wild-type Ad virus (Nevins, et al. Cell 26/213-220 (1981); Gaynor, et al. Cell 33/683-693 (1983); Yang, et al. J Virol 70/7209-7212 (1996)). When using First Generation adenovirus vectors for immunization, vaccine antigens are presented to the immune system simultaneously with highly immunogenic Ad capsid proteins. The major problem with these adenovirus vectors is that the immune responses generated are less likely to be directed to the desired vaccine epitopes (McMichael, et al. Nat Rev Immunol 2/283-291 (2002)) and more likely to be directed to the adenovirus-derived antigens, i.e., antigenic competition. There is controversy about the mechanism by which First Generation adenovirus vectors are potent immunogens. It has been hypothesized that the composition of the Ad capsid or a toxic effect of viral genes creates generalized inflammation resulting in a nonspecific immune stimulatory effect. The E1 proteins of Ad act to inhibit inflammation following infection (Schaack, et al. PNAS 101/3124-3129 (2004)). Removal of the gene segments for these proteins, which is the case for First Generation adenovirus vectors, results in increased levels of inflammation (Schaack, et al. PNAS 101/3124-3129 (2004); Schaack, et al. Viral Immunol 18/79-88 (2005)).

Thus, it is apparent that there remains a need for a more effective cancer vaccine vector candidate. In particular, there remains a need in the art for cancer targeting Ad vaccine vectors that allow multiple vaccinations and vaccinations in individuals with preexisting immunity to Ad. The present invention provides this and other advantages.

BRIEF SUMMARY

In a first aspect, the invention relates to a composition comprising a recombinant nucleic acid vector comprising a sequence with a first identity value of at least 80% to SEQ ID NO: 3. In some embodiments, the recombinant nucleic acid vector further comprises a region with a second identity value of at least 80% to a region in SEQ ID NO: 3, wherein the region is selected from 26048-26177, 26063-26141, 1-103, 54-103, 32214-32315, and 32214-32262. In some embodiments, the recombinant nucleic acid vector further comprises a region encoding a peptide with a third identity value of at least 80% to a peptide encoded by a region in SEQ ID NO: 3 between positions 1057 and 3165. In some embodiments, the first identity value is at least 90%. In some embodiments, the first identity value is at least 95%. In some embodiments, the first identity value is at least 99%. In some embodiments, the first identity value is 100%. In some embodiments, the second identity value is at least 90%. In some embodiments, the second identity value is at least 95%. In some embodiments, the second identity value is at least 99%. In some embodiments, the second identity value is 100%. In some embodiments, the third identity value is at least 90%. In some embodiments, the third identity value is at least 95%. In some embodiments, the third identity value is at least 99%. In some embodiments, the third identity value is 100%.

In a second aspect, the invention relates to a composition comprising a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a sequence with a first identity value of at least 80% to SEQ ID NO: 2; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus vector. In some embodiments, the replication defective adenovirus vector comprises a replication defective adenovirus 5 vector. In some embodiments, the replication defective adenovirus vector comprises a deletion in the E2b region. In some embodiments, the replication defective adenovirus vector further comprises a deletion in the E1 region. In some embodiments, the first identity value is at least 90%. In some embodiments, the first identity value is at least 95%. In some embodiments, the first identity value is at least 99%. In some embodiments, the first identity value is 100%. In some embodiments, the first identity value is at least 90%. In some embodiments, the first identity value is at least 95%. In some embodiments, the first identity value is at least 99%. In some embodiments, the first identity value is 100%. In some embodiments, the first identity value is at least 90%. In some embodiments, the first identity value is at least 95%. In some embodiments, the first identity value is at least 99%. In some embodiments, the first identity value is 100%.

In a third aspect, the invention relates to a composition comprising a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a modification in up to 25 amino acids; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus 5 vector having a deletion in the E2b region. In some embodiments, the modified CEA comprises a modification in up to 20 amino acids. In some embodiments, the modified CEA comprises a modification in up to 15 amino acids. In some embodiments, the modified CEA comprises a modification in up to 10 amino acids. In some embodiments, the modified CEA comprises a modification in up to 5 amino acids. In some embodiments, the recombinant nucleic acid vector is capable of effecting overexpression of the modified CEA in transfected cells. In some embodiments, the recombinant nucleic acid vector is capable of inducing a specific immune response against cells expressing CEA in a human that is at least 25 fold over basal. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 200. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 4767. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the composition further comprises an immunogenic component. In some embodiments, the immunogenic component comprises a cytokine selected from the group of. IFN-γ, TNFα IL-2, IL-8, IL-12, IL-18, IL-7, IL-3, IL-4, IL-5, IL-6, IL-9, IL-10, and IL-13. In some embodiments, the immunogenic component is selected from the group consisting of IL-7, a nucleic acid encoding IL-7, a protein with substantial identity to IL-7, and a nucleic acid encoding a protein with substantial identity to IL-7. In some embodiments, the modified CEA comprises a modification in 1 amino acid compared to wild type. In some embodiments, the modification comprises a substitution into aspartate in a position corresponding to position 610 in SEQ. ID. NO. 3.

In a fourth aspect, the invention relates to a composition comprising a recombinant nucleic acid vector, wherein the recombinant nucleic acid vector comprises a replication defective adenovirus vector, and wherein upon administration to a human, the composition is capable of inducing an immune response directed towards cells expressing CEA antigen in said human; wherein the immune response comprises cell mediated immunity. In some embodiments, the replication defective adenovirus vector comprises a replication defective adenovirus 5 vector. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor.

In a fifth aspect, the invention relates to a vial comprising a composition consisting of a therapeutic solution of a volume in the range of 0.8-1.2 ml, the therapeutic solution comprising 4.5-5.5×10¹¹ virus particles; wherein the virus particle is a replication defective adenovirus comprising a recombinant nucleic acid vector. In some embodiments, the recombinant nucleic acid vector is capable of effecting overexpression of the modified CEA in transfected cells. In some embodiments, the replication defective adenovirus comprises a nucleic acid sequence encoding a protein that is capable of inducing a specific immune response against CEA expressing cells in a human. In some embodiments, the replication defective adenovirus vector comprises a replication defective adenovirus 5 vector. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the therapeutic solution comprises 4.8-5.2×10¹¹ virus particles. In some embodiments, the therapeutic solution comprises 4.9-5.1×10¹¹ virus particles. In some embodiments, the therapeutic solution comprises 4.95-5.05×10¹¹ virus particles. In some embodiments, the therapeutic solution comprises 4.99-5.01×10¹¹ virus particles. In some embodiments, the replication defective adenovirus comprises a replication defective adenovirus 5. In some embodiments, the vial further comprises an immunogenic component. In some embodiments, the immunogenic component comprises a cytokine selected from the group of. IFN-γ, TNFα IL-2, IL-8, IL-12, IL-18, IL-7, IL-3, IL-4, IL-5, IL-6, IL-9, IL-10, and IL-13. In some embodiments, the immunogenic component is selected from the group consisting of IL-7, a nucleic acid encoding IL-7, a protein with substantial identity to IL-7, and a nucleic acid encoding a protein with substantial identity to IL-7.

In various aspects, the invention relates to methods of treatment with the compositions described herein, wherein the treatment comprises raising an immune response against CEA. In one aspect, the invention relates to a method of treatment comprising: (a) selecting a first phase and a second phase of treatment; (b) during the first phase, administering to a human a total of 3 times, in about 3 week intervals, a first replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human; and (c) during the second phase, administering to said human a total of 3 times, in about 3 month intervals, a second replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human; wherein the second phase starts about 3 months after the end of the first phase. In some embodiments, the first replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human and the second replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human are the same. In some embodiments, the first replication defective adenovirus comprises a replication defective adenovirus 5. In some embodiments, the second replication defective adenovirus comprises a replication defective adenovirus 5. In some embodiments, the first phase is at least five weeks. In some embodiments, the second phase is at least 5 months. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the first or second replication defective adenovirus infects dendritic cells in the human and wherein the infected dendritic cells present CEA antigen, thereby inducing the immune response. In some embodiments, the administering steps comprise subcutaneous administration. In some embodiments, the administering step in b or c comprises delivering 4.8-5.2×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.9-5.1×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.95-5.05×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.99-5.01×10¹¹ replication defective adenovirus particles. In some embodiments, the human carries an inverse Ad5 neutralizing antibody titer that is of greater than 200 prior to the administering step. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 4767. In some embodiments, the human is not concurrently being treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy. In some embodiments, the human has not been treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy prior to the administering step. In some embodiments, the human does not have an autoimmune disease. In some embodiments, the human does not have inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, multiple sclerosis, viral hepatitis, or HIV. In some embodiments, the human is not undergoing cytotoxic chemotherapy concurrently. In some embodiments, the human is not undergoing radiation therapy concurrently. In some embodiments, the human has autoimmune related thyroid disease or vitiligo. In some embodiments, the human has colorectal adenocarcinoma, metastatic colorectal cancer, advanced CEA expressing colorectal cancer, breast cancer, lung cancer, bladder cancer, or pancreas cancer. In some embodiments, the human has three sites of metastatic disease. In some embodiments, the human has received chemotherapy prior to the administering step. In some embodiments, prior to the first phase, the human has received at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, and panitumumab. In some embodiments, the human concurrently receives chemotherapy or radiation therapy treatment. In some embodiments, the human concurrently receives a therapy comprising the administration of at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, panitumumab, and acetinophen. In some embodiments, the human comprises cells overexpressing CEA. In some embodiments, the cells overexpressing CEA overexpress CEA by at least 10 times over the baseline CEA expression in a non-cancer cell. In some embodiments, cells overexpressing CEA comprise cancer cells. In some embodiments, cells overexpressing CEA are not gastrointestinal epithelium cells. In some embodiments, cells overexpressing CEA overexpress CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21, PSG1, PSG2, PSG3, PSG4, PSG5, PSG6, PSG7, PSG8, PSG9, or PSG11. In some embodiments, the human expresses a human leukocyte antigen of serotype HLA-A2, HLA-A3, or HLA-A24. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a modification in up to 5 amino acids; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus 5 vector having a deletion in the E2b region. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence with a first identity value of at least 80% to SEQ ID NO: 3. In some embodiments, the recombinant nucleic acid vector further comprises a region with a second identity value of at least 80% to a region in SEQ ID NO: 3, wherein the region is selected from 26048-26177, 26063-26141, 1-103, 54-103, 32214-32315, and 32214-32262. In some embodiments, the recombinant nucleic acid vector further comprises a region encoding a peptide with a third identity value of at least 80% to a peptide encoded by a region in SEQ ID NO: 3 between positions 1057 and 3165. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a sequence with a first identity value of at least 80% to SEQ ID NO: 2; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus vector.

In a further aspect, the invention relates to a method of treatment comprising: (a) selecting a first phase and a second phase of treatment; (b) during the first phase, administering to a human, a total of n times, a first replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human; and (c) during the second phase, administering said human, a total of m times, a second replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human. In some embodiments, the first replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human and the second replication defective adenovirus encoding an antigen that is capable of inducing an immune response directed towards cells expressing CEA antigen in a human are the same. In some embodiments, the first replication defective adenovirus comprises a replication defective adenovirus 5. In some embodiments, the second replication defective adenovirus comprises a replication defective adenovirus 5. In some embodiments, n is greater than 1. In some embodiments, n is 3. In some embodiments, m is greater than 1. In some embodiments, m is 3. In some embodiments, the first phase is about six weeks. In some embodiments, the first phase is at least five weeks. In some embodiments, the second phase is at least 5 months. In some embodiments, the second phase starts 3 weeks-16 weeks after first phase ends. In some embodiments, in the first phase two administrations of the replication defective adenovirus are at least 18 days apart. In some embodiments, in the first phase two administrations of the replication defective adenovirus are about 21 days apart. In some embodiments, in the first phase two administrations of the replication defective adenovirus are at most 24 days apart. In some embodiments, in the second phase two administrations of the replication defective adenovirus are at least 10 weeks apart. In some embodiments, in the second phase two administrations of the replication defective adenovirus are about 13 weeks apart. In some embodiments, in the second phase two administrations of the replication defective adenovirus are at most 16 weeks apart. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the first or second replication defective adenovirus infects dendritic cells in the human and wherein the infected dendritic cells present CEA antigen, thereby inducing the immune response. In some embodiments, the administering steps comprise subcutaneous administration. In some embodiments, the administering step in b or c comprises delivering 4.8-5.2×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.9-5.1×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.95-5.05×10¹¹ replication defective adenovirus particles. In some embodiments, the administering step in b or c comprises delivering 4.99-5.01×10¹¹ replication defective adenovirus particles. In some embodiments, the human carries an inverse Ad5 neutralizing antibody titer that is of greater than 200 prior to the administering step. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 4767. In some embodiments, the human is not concurrently being treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy. In some embodiments, the human has not been treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy prior to the administering step. In some embodiments, the human does not have an autoimmune disease. In some embodiments, the human does not have inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, multiple sclerosis, viral hepatitis, or HIV. In some embodiments, the human is not undergoing cytotoxic chemotherapy concurrently. In some embodiments, the human is not undergoing radiation therapy concurrently. In some embodiments, the human has autoimmune related thyroid disease or vitiligo. In some embodiments, the human has colorectal adenocarcinoma, metastatic colorectal cancer, advanced CEA expressing colorectal cancer breast cancer, lung cancer, bladder cancer or pancreas cancer. In some embodiments, the human has three sites of metastatic disease. In some embodiments, the human has received chemotherapy prior to the administering step. In some embodiments, prior to the first phase, the human has received at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, and panitumumab. In some embodiments, the human concurrently receives chemotherapy or radiation therapy treatment. In some embodiments, the human concurrently receives a therapy comprising the administration of at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, panitumumab, and acetinophen. In some embodiments, the human comprises cells overexpressing CEA. In some embodiments, the cells overexpressing CEA overexpress CEA more than 20 times over the baseline CEA expression in a non-cancer cell. In some embodiments, cells overexpressing CEA comprise cancer cells. In some embodiments, cells overexpressing CEA are not gastrointestinal epithelium cells. In some embodiments, cells overexpressing CEA overexpress CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21, PSG1, PSG2, PSG3, PSG4, PSG5, PSG6, PSG7, PSG8, PSG9, or PSG11. In some embodiments, the human expresses a human leukocyte antigen of serotype HLA-A2, HLA-A3, or HLA-A24. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a modification in up to 5 amino acids; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus 5 vector having a deletion in the E2b region. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence with a first identity value of at least 80% to SEQ ID NO: 3. In some embodiments, the recombinant nucleic acid vector further comprises a region with a second identity value of at least 80% to a region in SEQ ID NO: 3, wherein the region is selected from 26048-26177, 26063-26141, 1-103, 54-103, 32214-32315, and 32214-32262. In some embodiments, the recombinant nucleic acid vector further comprises a region encoding a peptide with a third identity value of at least 80% to a peptide encoded by a region in SEQ ID NO: 3 between positions 1057 and 3165. In some embodiments, the first or second replication defective adenovirus comprises a recombinant nucleic acid vector comprising a sequence encoding a modified CEA; wherein the modified CEA comprises a sequence with a first identity value of at least 80% to SEQ ID NO: 2; and wherein the recombinant nucleic acid vector comprises a replication defective adenovirus vector.

In another aspect, the invention relates to a method of generating an immune response against CEA in a human, the method comprising: (a) administering to the human the composition as in any of the previous aspects described herein, thereby increasing the immune response to CEA by at least 25 fold. In some embodiments, the immune response is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the immune response is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the immune response is measured as CEA antigen specific IL-2 secretion. In some embodiments, the immune response against CEA is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the immune response is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the recombinant nucleic acid vector infects dendritic cells in the human and wherein the infected dendritic cells present CEA antigen, thereby inducing the immune response. In some embodiments, the administering step comprises subcutaneous administration. In some embodiments, the administering step is repeated at least once. In some embodiments, the administering step is repeated after about 3 weeks following a previous administering step. In some embodiments, the administering step is repeated after about 3 months following a previous administering step. In some embodiments, the administering step is repeated twice. In some embodiments, the composition comprises 4.8-5.2×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.9-5.1×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.95-5.05×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.99-5.01×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the human carries an Ad5 neutralizing antibody titer that is of greater than 200 prior to the administering step. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 4767. In some embodiments, the human is not concurrently being treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy. In some embodiments, the human has not been treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy prior to the administering step. In some embodiments, the human does not have an autoimmune disease. In some embodiments, the human does not have inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, multiple sclerosis, viral hepatitis, or HIV. In some embodiments, the human is not undergoing cytotoxic chemotherapy concurrently. In some embodiments, the human is not undergoing radiation therapy concurrently. In some embodiments, the human has autoimmune related thyroid disease or vitiligo. In some embodiments, the human has colorectal adenocarcinoma, metastatic colorectal cancer, advanced CEA expressing colorectal cancer breast cancer, lung cancer, bladder cancer, or pancreas cancer. In some embodiments, the human has three sites of metastatic disease. In some embodiments, the human has received chemotherapy prior to the administering step. In some embodiments, prior to the administering step, the human has received at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, and panitumumab. In some embodiments, the human concurrently receives chemotherapy or radiation therapy treatment. In some embodiments, the human concurrently receives a therapy comprising the administration of at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, panitumumab, and acetinophen. In some embodiments, the human comprises cells overexpressing CEA. In some embodiments, the cells overexpressing CEA overexpress CEA more than 10 times over the baseline CEA expression in a non-cancer cell. In some embodiments, cells overexpressing CEA comprise cancer cells. In some embodiments, cells overexpressing CEA are not gastrointestinal epithelium cells. In some embodiments, cells overexpressing CEA overexpress CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21, PSG1, PSG2, PSG3, PSG4, PSG5, PSG6, PSG7, PSG8, PSG9, or PSG11. In some embodiments, the human expresses a human leukocyte antigen of serotype HLA-A2, HLA-A3, or HLA-A24.

In yet another aspect, the invention relates to a method of selecting a human for administration of the composition as in any of the previous aspects described herein, comprising; (a) determining a HLA subtype of the human; and (b) administering the composition to the human, if the HLA subtype is determined to be one of a preselected subgroup of HLA subtypes. In some embodiments, the preselected subgroup of HLA subtypes comprises one or more of HLA-A2, HLA-A3, or HLA-A24. In some embodiments, the method induces a CEA-specific immune response that is measured as CEA antigen specific cell-mediated immunity (CMI). In some embodiments, the method induces a CEA-specific immune response that is measured as CEA antigen specific IFN-γ secretion. In some embodiments, the method induces a CEA-specific immune response that is measured as CEA antigen specific IL-2 secretion. In some embodiments, the method induces a CEA-specific immune response against CEA that is measured by ELISspot assay. In some embodiments, the CEA antigen specific CMI is greater than 300 IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). In some embodiments, the method induces a CEA-specific immune response that is measured by T cell lysis of CAP-1 pulsed antigen-presenting cells, allogeneic CEA expressing cells from a tumor cell line or from an autologous tumor. In some embodiments, the recombinant nucleic acid vector infects dendritic cells in the human and wherein the infected dendritic cells present CEA antigen, thereby inducing an immune response. In some embodiments, the administering step comprises subcutaneous administration. In some embodiments, the administering step is repeated at least once. In some embodiments, the administering step is repeated after about 3 weeks following a previous administering step. In some embodiments, the administering step is repeated after about 3 months following a previous administering step. In some embodiments, the administering step is repeated twice. In some embodiments, the composition comprises 4.8-5.2×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.9-5.1×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.95-5.05×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the composition comprises 4.99-5.01×10¹¹ virus particles comprising the recombinant nucleic acid vector. In some embodiments, the human carries an inverse Ad5 neutralizing antibody titer that is of greater than 200 prior to the administering step. In some embodiments, the human has an inverse Ad5 neutralizing antibody titer of greater than 4767. In some embodiments, the human is not concurrently being treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy. In some embodiments, the human has not been treated by any one of steroids, corticosteroids, immunosuppressive agents, and immunotherapy prior to the administering step. In some embodiments, the human does not have an autoimmune disease. In some embodiments, the human does not have inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, multiple sclerosis, viral hepatitis, or HIV. In some embodiments, the human is not undergoing cytotoxic chemotherapy concurrently. In some embodiments, the human is not undergoing radiation therapy concurrently. In some embodiments, the human has autoimmune related thyroid disease or vitiligo. In some embodiments, the human has colorectal adenocarcinoma, metastatic colorectal cancer, advanced CEA expressing colorectal cancer breast cancer, lung cancer, bladder cancer, or pancreas cancer. In some embodiments, the human has three sites of metastatic disease. In some embodiments, the human has received chemotherapy prior to the administering step. In some embodiments, prior to the administering step, the human has received at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, and panitumumab. In some embodiments, the human concurrently receives chemotherapy or radiation therapy treatment. In some embodiments, the human concurrently receives a therapy comprising the administration of at least one medication of the group consisting of fluoropyrimidine, irinotecan, oxaliplatin, bevacizunab, Capecitabine, Mitomycin, Regorafenib, cetuxinab, panitumumab, and acetinophen. In some embodiments, the human comprises cells overexpressing CEA. In some embodiments, the cells overexpressing CEA overexpress CEA more than 10 times over the baseline CEA expression in a non-cancer cell. In some embodiments, cells overexpressing CEA comprise cancer cells. In some embodiments, cells overexpressing CEA are not gastrointestinal epithelium cells. In some embodiments, cells overexpressing CEA overexpress CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21, PSG1, PSG2, PSG3, PSG4, PSG5, PSG6, PSG7, PSG8, PSG9, or PSG11.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

FIG. 1 is a bar graph showing antibody levels from mice immunized with Ad5Null. Mice were immunized three times with Ad5Null viral particles at 14 day intervals. Note the presence of increasing anti-Ad antibody levels after each immunization.

FIG. 2 is a bar graph showing neutralizing antibody levels from mice immunized with Ad5Null. Mice were immunized three times with Ad5Null viral particles at 14 day intervals. Note the presence of increasing neutralizing antibodies after each immunization. Optical density readings indicate the presence of viable target cells.

FIG. 3 is a bar graph showing the induction of NAb in C57BI/6 mice after injections with Ad5-Null vector platform (VP). Note the increasing levels of NAb induced in mice after repeated injections with Ad particles. Values represent mean±SEM.

FIG. 4A is a bar graph showing INF-.γ. secreting splenocytes from Ad5 immune mice immunized with Ad5 [E1-]-CEA or Ad5 [E1, E2b-]-CEA. Note the significantly elevated response in splenocytes from the Ad5 [E1-, E2b]-CEA immunized group. Values represent mean±SEM.

FIG. 4B is a bar graph showing IL-2 secreting splenocytes from Ad5 immune mice immunized with Ad5 [E1-]-CEA or Ad5 [E1-, E2b-]-CEA. Note the significantly elevated response in splenocytes from the Ad5 [E1-, E2b]-CEA immunized group. Values represent mean±SEM.

FIG. 5 is a bar graph showing serum AST levels in control mice and mice vaccinated with 10¹⁰ viral particles of Ad5 [E1-]-CEA or Ad5 [E1-, E2b-]-CEA. Values represent mean±SEM.

FIG. 6 is a line graph showing tumor volume. Ad5 immune C57BI/6 mice were injected with MC38 CEA expressing tumor cells and subsequently treated (Vac) with Ad5 [E1-, E2b-]-CEA vaccine as described. Note the significant reduction in tumor size by days 19-21 as compared to untreated control tumor bearing mice. Tumor measurements were taken and volumes were determined. Statistical analysis was performed using the Bonferroni post-tests analysis with PRISM software. Values represent mean±SEM.

FIG. 7 is a graph showing tumor weights from treated and untreated Ad5 immune MC38 tumor bearing mice. Note the significant (p=0.0124) reduction in tumor weights from the mice treated with Ad5 [E1-, E2b-]-CEA. Values represent mean±SEM.

FIG. 8 is a representative immunoblot demonstrating Gag production by A-549 cells infected with Ad5 [E1-, E2b-]-gag. A-549 whole cell lysate was infected at a MOI of 200 of Ad5 [E1-, E2b-]-gag or Ad5-null for 44 h. The blot was stained with a mouse monoclonal antibody against Gag. Lane 1, Magic Mark XP Western Standard (Invitrogen, CA), Lanes 2 and 3, Ad5 [E1-, E2b-]-gag, Lane 4, Ad5-null (empty). The upper band (55 kDa) comprises the gag precursor and the lower band (41 kDa) comprises the p17/p24 gag complex.

FIG. 9 demonstrates the effect of multiple immunizations on inducing a greater CMI (IFN-γ ELISpot) response. Ad5 Naïve BALB/C mice (n=5/group) were immunized once or three times at fourteen day intervals with 10¹⁰ VP of Ad5 [E1-]-null, Ad5 [E1-, E2b-]-null, Ad5 [E1-]-gag, Ad5 [E1-, E2b-]-gag, or injection buffer alone (control). Fourteen days after the final immunization splenocytes were assessed for IFN-γ secreting splenocytes by ELISpot analysis. For positive controls, splenocytes were exposed to Concanavalin A (Con A) (data not shown). The error bars depict the SEM

FIG. 10 shows the results of ELISpot INF-γ (A) and IL-2 (B) analysis of PBMC from Cynomolgus Macaques (N=3) pre-immunized against Wild Type Ad5. When Ad5 neutralizing antibody titers reached 1:50 or greater they were immunized intradermally three times at 30 day intervals with Ad5-[E1-, E2b-]-gag at a dose of 10¹⁰ VP. The first immunization (Wild Type Ad5) was on day 1 and 124 days later (32 days after last vaccination) the NAb titers were equal to or greater than 1:1000. Note the presence of significantly elevated values (P<0.05) in the Dec. 17, 2007 samples. For positive controls, splenocytes were exposed to Concanavalin A (Con A) (data not shown). Values represent mean±SEM.

FIG. 11 ELISpot interferon-γ secreting SPC from mice vaccinated with recombinant Ad5 CEA expression vectors. Graph shows lack of reduction in SPC from mice vaccinated with Ad5 [[E1-, E2b-]-CEA as compared with the reductions in SPC from Ad5 [E1-]-CEA vaccinated mice.

FIG. 12 demonstrates Kaplan-Meier survival plots of patients treated with Ad5 [E1-, E2b-]-CEA(6D). Patients treated with Ad5 [E1-, E2b-]-CEA(6D) were followed for survival. Panel A represents 7 patients in cohorts 1 and 2 that were followed for survival. There were 5 events in this group. Panel B represents 21 patients in cohort 3 and Ph II that were followed for survival. There were 11 events in this group. Panel C represents 6 patients in cohort 5 that were followed for survival. There were 3 events in this group. Panel D represents all 34 that were followed for survival. There were 19 events in this group.

FIG. 13 demonstrates Kaplan-Meier survival plots of patients treated with Ad5 [E1-, E2b-]-CEA(6D). Patients treated three times with Ad5 [E1-, E2b-]-CEA(6D) were followed for survival. Panel A represents 28 patients that were followed for survival. There were 11 events in this group. Panel B represents 27 patients that were followed for survival. There were 11 events in this group.

FIG. 14 demonstrates CEA-directed CMI responses in treated patients. CMI (IFN-γ secretion) was assessed at baseline (Pre) and after administrations of Ad5 [E1-, E2b-]-CEA(6D) (Post). The highest CMI responses (regardless of time point) observed in the patients after treatment revealed a dose response. The highest CMI levels occurred in patients that received the highest dose of 5×10″ VP (Cohort 5). The CMI responses for Cohort 3/Phase II and Cohort 5 were significantly elevated (P=0.0002 and P=0.0317, respectively; Mann-Whitney test) as compared to their baseline (Pre) values. Specificity of the responses was demonstrated by the lack of reactivity with the irrelevant antigens β-galactosidase and HIV-gag (data not shown). For positive controls, PBMCs were exposed to concanavalin A (data not shown). Values=Mean±SEM for each Cohort.

FIG. 15 demonstrates CEA directed CMI responses in treated patients. CMI (IFN-γ secretion) was assessed at baseline (week 0) and 3 weeks after the last immunotherapy (week 9) for patients in all 4-dose cohorts. A dose response was observed and the highest CMI level occurred in patients that received the highest dose. The CMI response with the highest dose was significantly elevated (P<0.02; Mann-Whitney test). Specificity of the responses was demonstrated by the lack of reactivity with the irrelevant antigens β-galactosidase and HIV-gag (data not shown). For positive controls, PBMCs were exposed to concanavalin A (data not shown). Horizontal line and error bar indicate the mean±SEM.

FIG. 16 demonstrates Ad5 immune responses in patients receiving immunizations with Ad5 [E1-, E2b-]-CEA(6D) vaccine. Ad5 NAb titers (A) and CMI responses (B) to Ad5 were determined in patients at baseline (week 0) and 3 weeks (week 9) after the third immunization. The number of IFN-γ secreting PBMCs from patients that were specific for Ad5 was determined by ELISpot. Both the Ad5 NAb titers and Ad5 CMI responses were significantly elevated at week 9 (P<0.0001 and P<0.01, respectively; Mann-Whitney test). Values=Mean±SEM.

FIG. 17 demonstrates CEA-specific immunity in patients receiving immunizations with Ad5 [E1-, E2b-]-CEA(6D) vaccine and comparisons with Ad5 immunity. (A) The mean CEA specific immune responses in patients (n=19) who received 1×10¹¹ VP of Ad5 [E1-, E2b-]-CEA(6D) as measured by IFN-γ secretion of PBMC in patients with none to low pre-existing Ad5 immunity (NAb<200, white bars) as compared to the CEA specific immune response of patients with high pre-existing Ad5 immunity (NAb titer≧200, black bars) prior to the initiation of treatment with Ad5 [E1-, E2b-]-CEA(6D). There was no significant difference between the two groups at any time point tested (P>0.4, Mann-Whitney test) (Values=Mean±SEM). (B) Correlation between pre-existing Ad5 NAb activity and highest levels of induced CEA CMI responses. (C) Correlation between vector induced Ad5 NAb activity and CEA CMI responses. The r² values in B and C revealed no correlation between pre-existing or vector induced Ad5 NAb activity and CEA CMI ELISpot responses.

DETAILED DESCRIPTION

The present invention relates to methods and adenovirus vectors for generating immune responses against target antigens, in particular, those related to cancer cells. In various aspects of the invention, compositions and methods described herein relate to generating an immune response against cells expressing and/or presenting a target antigen, such as colorectal embryonic antigen (CEA). In some embodiments, a modified form of CEA is used in a vaccine directed to raising an immune response against CEA or cells expressing and/or presenting CEA. In particular, the present invention provides an improved adenovirus (Ad)-based vaccine such that multiple vaccinations against one or more antigenic target entity can be achieved. In some embodiments, the improved adenovirus (Ad)-based vaccine comprises a replication defective adenovirus carrying a target antigen, a fragment, a variant or a variant fragment thereof, such as Ad5 [E1-,E2b-]-CEA(6D). Variants and/or fragments of target antigens, for example CEA, can be selected based on a variety of factors, including immunogenic potential. Accordingly, a mutant CEA, CEA(6D) is utilized in various embodiments of the invention for its increased capability to raise an immune response relative to the wild type form. Importantly, vaccination can be performed in the presence of preexisting immunity to the Ad and/or administered to subjects previously immunized multiple times with the adenovirus vector of the present invention or other adenovirus vectors. The adenovirus vectors of the invention can be administered to subjects multiple times to induce an immune response against an antigen of interest, for example CEA, including but not limited to, the production of antibodies and cell-mediated immune responses against one or more target antigens.

The following passages describe different aspects of the invention in greater detail. Each aspect of the invention may be combined with any other aspect or aspects of the invention unless clearly indicated to the contrary. In particular, any feature indicated as being preferred or advantageous may be combined with any other feature of features indicated as being preferred or advantageous.

To facilitate an understanding of the present invention, a number of terms and phrases are defined below.

As used herein, unless otherwise indicated, the article “a” means one or more unless explicitly otherwise provided for.

As used herein, unless otherwise indicated, terms such as “contain,” “containing,” “include,” “including,” and the like mean “comprising.”

As used herein, unless otherwise indicated, the term “or” can be conjunctive or disjunctive.

As used herein, unless otherwise indicated, any embodiment can be combined with any other embodiment.

As used herein, unless otherwise indicated, some inventive embodiments herein contemplate numerical ranges. A variety of aspects of this invention can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Accordingly, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range as if explicitly written out. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 3, 4, 5, and 6. This applies regardless of the breadth of the range. When ranges are present, the ranges include the range endpoints.

The term “adenovirus” or “Ad” refers to a group of non-enveloped DNA viruses from the family Adenoviridae. In addition to human hosts, these viruses can be found in, but are not limited to, avian, bovine, porcine and canine species. The present invention contemplates the use of any adenovirus from any of the four genera of the family Adenoviridae (e.g., Aviadenovirus, Mastadenovirus, Atadenovirus and Siadenovirus) as the basis of an E2b deleted virus vector, or vector containing other deletions as described herein. In addition, several serotypes are found in each species. Ad also pertains to genetic derivatives of any of these viral serotypes, including but not limited to, genetic mutation, deletion or transposition of homologous or heterologous DNA sequences.

A “helper adenovirus” or “helper virus” refers to an Ad that can supply viral functions that a particular host cell cannot (the host may provide Ad gene products such as E1 proteins). This virus is used to supply, in trans, functions (e.g., proteins) that are lacking in a second virus, or helper dependent virus (e.g., a gutted or gutless virus, or a virus deleted for a particular region such as E2b or other region as described herein); the first replication-incompetent virus is said to “help” the second, helper dependent virus thereby permitting the production of the second viral genome in a cell.

The term “Adenovirus5 null (Ad5null)”, as used herein, refers to a non-replicating Ad that does not contain any heterologous nucleic acid sequences for expression.

The term “First Generation adenovirus”, as used herein, refers to an Ad that has the early region 1 (E1) deleted. In additional cases, the nonessential early region 3 (E3) may also be deleted.

The term “gutted” or “gutless”, as used herein, refers to an adenovirus vector that has been deleted of all viral coding regions.

The term “transfection” as used herein refers to the introduction of foreign nucleic acid into eukaryotic cells. Transfection may be accomplished by a variety of means known to the art including calcium phosphate-DNA co-precipitation, DEAE-dextran-mediated transfection, polybrene-mediated transfection, electroporation, microinjection, liposome fusion, lipofection, protoplast fusion, retroviral infection, and biolistics.

The term “stable transfection” or “stably transfected” refers to the introduction and integration of foreign nucleic acid, DNA or RNA, into the genome of the transfected cell. The term “stable transfectant” refers to a cell which has stably integrated foreign DNA into the genomic DNA.

The term “reporter gene” indicates a nucleotide sequence that encodes a reporter molecule (including an enzyme). A “reporter molecule” is detectable in any of a variety of detection systems, including, but not limited to enzyme-based detection assays (e.g., ELISA, as well as enzyme-based histochemical assays), fluorescent, radioactive, and luminescent systems. In one embodiment, the present invention contemplates the E. coli β-galactosidase gene (available from Pharmacia Biotech, Pistacataway, N.J.), green fluorescent protein (GFP) (commercially available from Clontech, Palo Alto, Calif.), the human placental alkaline phosphatase gene, the chloramphenicol acetyltransferase (CAT) gene; other reporter genes are known to the art and may be employed.

As used herein, the terms “nucleic acid molecule encoding,” “DNA sequence encoding,” and “DNA encoding” refer to the order or sequence of deoxyribonucleotides along a strand of deoxyribonucleic acid. The order of these deoxyribonucleotides determines the order of amino acids along the polypeptide (protein) chain. The nucleic acid sequence thus codes for the amino acid sequence.

The term “heterologous nucleic acid sequence”, as used herein, refers to a nucleotide sequence that is ligated to, or is manipulated to become ligated to, a nucleic acid sequence to which it is not ligated in nature, or to which it is ligated at a different location in nature. Heterologous nucleic acid may include a nucleotide sequence that is naturally found in the cell into which it is introduced or the heterologous nucleic acid may contain some modification relative to the naturally occurring sequence.

The term “transgene” refers to any gene coding region, either natural or heterologous nucleic acid sequences or fused homologous or heterologous nucleic acid sequences, introduced into the cells or genome of a test subject. In the current invention, transgenes are carried on any viral vector that is used to introduce the transgenes to the cells of the subject.

The term “Second Generation Adenovirus”, as used herein, refers to an Ad that has all or parts of the E1, E2, E3, and, in certain embodiments, E4 DNA gene sequences deleted (removed) from the virus.

The term “subject”, as used herein, refers to any animal, e.g., a mammal or marsupial. Subjects of the present invention include but are not limited to humans, non-human primates (e.g., rhesus or other types of macaques), mice, pigs, horses, donkeys, cows, sheep, rats and fowl of any kind.

In particular embodiments, the present invention relates to a replication defective adenovirus vector of serotype 5 comprising a sequence encoding an immunogenic polypeptide. The immunogenic polypeptide may be a mutant CEA or a fragment thereof. In some embodiments, the immunogenic polypeptide comprises a mutant CEA with an Asn→Asp substitution at position 610. In some embodiments, the replication defective adenovirus vector comprises a sequence encoding a polypeptide with at least 75%, 80%, 85%, 90%, 95%, 98%, 99%, 99.5%, 99.9% identity to the immunogenic polypeptide. In some embodiments, the sequence encoding the immunogenic polypeptide comprises the following sequence identified by SEQ. ID. NO: 1:

(SEQ. ID. NO.: 1) ATGGAGTCTCCCTCGGCCCCTCCCCACAGATGGTGCATCCCCTGGCAGAG GCTCCTGCTCACAGCCTCACTTCTAACCTTCTGGAACCCGCCCACCACTG CCAAGCTCACTATTGAATCCACGCCGTTCAATGTCGCAGAGGGGAAGGAG GTGCTTCTACTTGTCCACAATCTGCCCCAGCATCTTTTTGGCTACAGCTG GTACAAAGGTGAAAGAGTGGATGGCAACCGTCAAATTATAGGATATGTAA TAGGAACTCAACAAGCTACCCCAGGGCCCGCATACAGTGGTCGAGAGATA ATATACCCCAATGCATCCCTGCTGATCCAGAACATCATCCAGAATGACAC AGGATTCTACACCCTACACGTCATAAAGTCAGATCTTGTGAATGAAGAAG CAACTGGCCAGTTCCGGGTATACCCGGAGCTGCCCAAGCCCTCCATCTCC AGCAACAACTCCAAACCCGTGGAGGACAAGGATGCTGTGGCCTTCACCTG TGAACCTGAGACTCAGGACGCAACCTACCTGTGGTGGGTAAACAATCAGA GCCTCCCGGTCAGTCCCAGGCTGCAGCTGTCCAATGGCAACAGGACCCTC ACTCTATTCAATGTCACAAGAAATGACACAGCAAGCTACAAATGTGAAAC CCAGAACCCAGTGAGTGCCAGGCGCAGTGATTCAGTCATCCTGAATGTCC TCTATGGCCCGGATGCCCCCACCATTTCCCCTCTAAACACATCTTACAGA TCAGGGGAAAATCTGAACCTCTCCTGCCACGCAGCCTCTAACCCACCTGC ACAGTACTCTTGGTTTGTCAATGGGACTTTCCAGCAATCCACCCAAGAGC TCTTTATCCCCAACATCACTGTGAATAATAGTGGATCCTATACGTGCCAA GCCCATAACTCAGACACTGGCCTCAATAGGACCACAGTCACGACGATCAC AGTCTATGCAGAGCCACCCAAACCCTTCATCACCAGCAACAACTCCAACC CCGTGGAGGATGAGGATGCTGTAGCCTTAACCTGTGAACCTGAGATTCAG AACACAACCTACCTGTGGTGGGTAAATAATCAGAGCCTCCCGGTCAGTCC CAGGCTGCAGCTGTCCAATGACAACAGGACCCTCACTCTACTCAGTGTCA CAAGGAATGATGTAGGACCCTATGAGTGTGGAATCCAGAACGAATTAAGT GTTGACCACAGCGACCCAGTCATCCTGAATGTCCTCTATGGCCCAGACGA CCCCACCATTTCCCCCTCATACACCTATTACCGTCCAGGGGTGAACCTCA GCCTCTCCTGCCATGCAGCCTCTAACCCACCTGCACAGTATTCTTGGCTG ATTGATGGGAACATCCAGCAACACACACAAGAGCTCTTTATCTCCAACAT CACTGAGAAGAACAGCGGACTCTATACCTGCCAGGCCAATAACTCAGCCA GTGGCCACAGCAGGACTACAGTCAAGACAATCACAGTCTCTGCGGAGCTG CCCAAGCCCTCCATCTCCAGCAACAACTCCAAACCCGTGGAGGACAAGGA TGCTGTGGCCTTCACCTGTGAACCTGAGGCTCAGAACACAACCTACCTGT GGTGGGTAAATGGTCAGAGCCTCCCAGTCAGTCCCAGGCTGCAGCTGTCC AATGGCAACAGGACCCTCACTCTATTCAATGTCACAAGAAATGACGCAAG AGCCTATGTATGTGGAATCCAGAACTCAGTGAGTGCAAACCGCAGTGACC CAGTCACCCTGGATGTCCTCTATGGGCCGGACACCCCCATCATTTCCCCC CCAGACTCGTCTTACCTTTCGGGAGCGAACCTCAACCTCTCCTGCCACTC GGCCTCTAACCCATCCCCGCAGTATTCTTGGCGTATCAATGGGATACCGC AGCAACACACACAAGTTCTCTTTATCGCCAAAATCACGCCAAATAATAAC GGGACCTATGCCTGTTTTGTCTCTAACTTGGCTACTGGCCGCAATAATTC CATAGTCAAGAGCATCACAGTCTCTGCATCTGGAACTTCTCCTGGTCTCT CAGCTGGGGCCACTGTCGGCATCATGATTGGAGTGCTGGTTGGGGTTGCT CTGATATAG,.

In some embodiments, the sequence encoding the immunogenic polypeptide comprises a sequence with at least 75%, 80%, 85%, 90%, 95%, 98%, 99%, 99.5%, 99.9% identity to SEQ. ID. NO: 1 or a sequence generated from SEQ. ID. NO: 1 by alternative codon replacements. In some embodiments, the immunogenic polypeptide encoded by the adenovirus vectors described herein comprising up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, or more point mutations, such as single amino acid substitutions or deletions, as compared to a wild-type human CEA sequence.

In some embodiments, the immunogenic polypeptide comprises a sequence from SEQ. ID. NO.: 2 or a modified version, e.g. comprising up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, or more point mutations, such as single amino acid substitutions or deletions, of SEQ. ID. NO.: 2:

SEQ. ID. NO.: 2 ATGGAGTCTCCCTCGGCCCCTCCCCACAGATGGTGCATCCCCTGGCAGAG GCTCCTGCTCACAGCCTCACTTCTAACCTTCTGGAACCCGCCCACCACTG CCAAGCTCACTATTGAATCCACGCCGTTCAATGTCGCAGAGGGGAAGGAG GTGCTTCTACTTGTCCACAATCTGCCCCAGCATCTTTTTGGCTACAGCTG GTACAAAGGTGAAAGAGTGGATGGCAACCGTCAAATTATAGGATATGTAA TAGGAACTCAACAAGCTACCCCAGGGCCCGCATACAGTGGTCGAGAGATA ATATACCCCAATGCATCCCTGCTGATCCAGAACATCATCCAGAATGACAC AGGATTCTACACCCTACACGTCATAAAGTCAGATCTTGTGAATGAAGAAG CAACTGGCCAGTTCCGGGTATACCCGGAGCTGCCCAAGCCCTCCATCTCC AGCAACAACTCCAAACCCGTGGAGGACAAGGATGCTGTGGCCTTCACCTG TGAACCTGAGACTCAGGACGCAACCTACCTGTGGTGGGTAAACAATCAGA GCCTCCCGGTCAGTCCCAGGCTGCAGCTGTCCAATGGCAACAGGACCCTC ACTCTATTCAATGTCACAAGAAATGACACAGCAAGCTACAAATGTGAAAC CCAGAACCCAGTGAGTGCCAGGCGCAGTGATTCAGTCATCCTGAATGTCC TCTATGGCCCGGATGCCCCCACCATTTCCCCTCTAAACACATCTTACAGA TCAGGGGAAAATCTGAACCTCTCCTGCCACGCAGCCTCTAACCCACCTGC ACAGTACTCTTGGTTTGTCAATGGGACTTTCCAGCAATCCACCCAAGAGC TCTTTATCCCCAACATCACTGTGAATAATAGTGGATCCTATACGTGCCAA GCCCATAACTCAGACACTGGCCTCAATAGGACCACAGTCACGACGATCAC AGTCTATGCAGAGCCACCCAAACCCTTCATCACCAGCAACAACTCCAACC CCGTGGAGGATGAGGATGCTGTAGCCTTAACCTGTGAACCTGAGATTCAG AACACAACCTACCTGTGGTGGGTAAATAATCAGAGCCTCCCGGTCAGTCC CAGGCTGCAGCTGTCCAATGACAACAGGACCCTCACTCTACTCAGTGTCA CAAGGAATGATGTAGGACCCTATGAGTGTGGAATCCAGAACGAATTAAGT GTTGACCACAGCGACCCAGTCATCCTGAATGTCCTCTATGGCCCAGACGA CCCCACCATTTCCCCCTCATACACCTATTACCGTCCAGGGGTGAACCTCA GCCTCTCCTGCCATGCAGCCTCTAACCCACCTGCACAGTATTCTTGGCTG ATTGATGGGAACATCCAGCAACACACACAAGAGCTCTTTATCTCCAACAT CACTGAGAAGAACAGCGGACTCTATACCTGCCAGGCCAATAACTCAGCCA GTGGCCACAGCAGGACTACAGTCAAGACAATCACAGTCTCTGCGGAGCTG CCCAAGCCCTCCATCTCCAGCAACAACTCCAAACCCGTGGAGGACAAGGA TGCTGTGGCCTTCACCTGTGAACCTGAGGCTCAGAACACAACCTACCTGT GGTGGGTAAATGGTCAGAGCCTCCCAGTCAGTCCCAGGCTGCAGCTGTCC AATGGCAACAGGACCCTCACTCTATTCAATGTCACAAGAAATGACGCAAG AGCCTATGTATGTGGAATCCAGAACTCAGTGAGTGCAAACCGCAGTGACC CAGTCACCCTGGATGTCCTCTATGGGCCGGACACCCCCATCATTTCCCCC CCAGACTCGTCTTACCTTTCGGGAGCGAACCTCAACCTCTCCTGCCACTC GGCCTCTAACCCATCCCCGCAGTATTCTTGGCGTATCAATGGGATACCGC AGCAACACACACAAGTTCTCTTTATCGCCAAAATCACGCCAAATAATAAC GGGACCTATGCCTGTTTTGTCTCTAACTTGGCTACTGGCCGCAATAATTC CATAGTCAAGAGCATCACAGTCTCTGCATCTGGAACTTCTCCTGGTCTCT CAGCTGGGGCCACTGTCGGCATCATGATTGGAGTGCTGGTTGGGGTTGCT CTGATATAG,.

The compositions and methods of the invention, in some embodiments, relate to an adenovirus-derived vector comprising the following sequence identified by SEQ. ID. NO: 3:

(SEQ. ID. NO: 3) CATCATCAATAATATACCTTATTTTGGATTGAAGCCAATATGATAATGAG GGGGTGGAGTTTGTGACGTGGCGCGGGGCGTGGGAACGGGGCGGGTGACG TAGTAGTGTGGCGGAAGTGTGATGTTGCAAGTGTGGCGGAACACATGTAA GCGACGGATGTGGCAAAAGTGACGTTTTTGGTGTGCGCCGGTGTACACAG GAAGTGACAATTTTCGCGCGGTTTTAGGCGGATGTTGTAGTAAATTTGGG CGTAACCGAGTAAGATTTGGCCATTTTCGCGGGAAAACTGAATAAGAGGA AGTGAAATCTGAATAATTTTGTGTTACTCATAGCGCGTAATACTGTAATA GTAATCAATTACGGGGTCATTAGTTCATAGCCCATATATGGAGTTCCGCG TTACATAACTTACGGTAAATGGCCCGCCTGGCTGACCGCCCAACGACCCC CGCCCATTGACGTCAATAATGACGTATGTTCCCATAGTAACGCCAATAGG GACTTTCCATTGACGTCAATGGGTGGAGTATTTACGGTAAACTGCCCACT TGGCAGTACATCAAGTGTATCATATGCCAAGTACGCCCCCTATTGACGTC AATGACGGTAAATGGCCCGCCTGGCATTATGCCCAGTACATGACCTTATG GGACTTTCCTACTTGGCAGTACATCTACGTATTAGTCATCGCTATTACCA TGGTGATGCGGTTTTGGCAGTACATCAATGGGCGTGGATAGCGGTTTGAC TCACGGGGATTTCCAAGTCTCCACCCCATTGACGTCAATGGGAGTTTGTT TTGGCACCAAAATCAACGGGACTTTCCAAAATGTCGTAACAACTCCGCCC CATTGACGCAAATGGGCGGTAGGCGTGTACGGTGGGAGGTCTATATAAGC AGAGCTGGTTTAGTGAACCGTCAGATCCGCTAGAGATCTGGTACCGTCGA CGCGGCCGCTCGAGCCTAAGCTTGGTACCGAGCTCGGATCCACTAGTAAC GGCCGCCAGTGTGCTGGAATTCGGCTTAAAGGTACCCAGAGCAGACAGCC GCCACCATGGAGTCTCCCTCGGCCCCTCCCCACAGATGGTGCATCCCCTG GCAGAGGCTCCTGCTCACAGCCTCACTTCTAACCTTCTGGAACCCGCCCA CCACTGCCAAGCTCACTATTGAATCCACGCCGTTCAATGTCGCAGAGGGG AAGGAGGTGCTTCTACTTGTCCACAATCTGCCCCAGCATCTTTTTGGCTA CAGCTGGTACAAAGGTGAAAGAGTGGATGGCAACCGTCAAATTATAGGAT ATGTAATAGGAACTCAACAAGCTACCCCAGGGCCCGCATACAGTGGTCGA GAGATAATATACCCCAATGCATCCCTGCTGATCCAGAACATCATCCAGAA TGACACAGGATTCTACACCCTACACGTCATAAAGTCAGATCTTGTGAATG AAGAAGCAACTGGCCAGTTCCGGGTATACCCGGAGCTGCCCAAGCCCTCC ATCTCCAGCAACAACTCCAAACCCGTGGAGGACAAGGATGCTGTGGCCTT CACCTGTGAACCTGAGACTCAGGACGCAACCTACCTGTGGTGGGTAAACA ATCAGAGCCTCCCGGTCAGTCCCAGGCTGCAGCTGTCCAATGGCAACAGG ACCCTCACTCTATTCAATGTCACAAGAAATGACACAGCAAGCTACAAATG TGAAACCCAGAACCCAGTGAGTGCCAGGCGCAGTGATTCAGTCATCCTGA ATGTCCTCTATGGCCCGGATGCCCCCACCATTTCCCCTCTAAACACATCT TACAGATCAGGGGAAAATCTGAACCTCTCCTGCCACGCAGCCTCTAACCC ACCTGCACAGTACTCTTGGTTTGTCAATGGGACTTTCCAGCAATCCACCC AAGAGCTCTTTATCCCCAACATCACTGTGAATAATAGTGGATCCTATACG TGCCAAGCCCATAACTCAGACACTGGCCTCAATAGGACCACAGTCACGAC GATCACAGTCTATGCAGAGCCACCCAAACCCTTCATCACCAGCAACAACT CCAACCCCGTGGAGGATGAGGATGCTGTAGCCTTAACCTGTGAACCTGAG ATTCAGAACACAACCTACCTGTGGTGGGTAAATAATCAGAGCCTCCCGGT CAGTCCCAGGCTGCAGCTGTCCAATGACAACAGGACCCTCACTCTACTCA GTGTCACAAGGAATGATGTAGGACCCTATGAGTGTGGAATCCAGAACGAA TTAAGTGTTGACCACAGCGACCCAGTCATCCTGAATGTCCTCTATGGCCC AGACGACCCCACCATTTCCCCCTCATACACCTATTACCGTCCAGGGGTGA ACCTCAGCCTCTCCTGCCATGCAGCCTCTAACCCACCTGCACAGTATTCT TGGCTGATTGATGGGAACATCCAGCAACACACACAAGAGCTCTTTATCTC CAACATCACTGAGAAGAACAGCGGACTCTATACCTGCCAGGCCAATAACT CAGCCAGTGGCCACAGCAGGACTACAGTCAAGACAATCACAGTCTCTGCG GAGCTGCCCAAGCCCTCCATCTCCAGCAACAACTCCAAACCCGTGGAGGA CAAGGATGCTGTGGCCTTCACCTGTGAACCTGAGGCTCAGAACACAACCT ACCTGTGGTGGGTAAATGGTCAGAGCCTCCCAGTCAGTCCCAGGCTGCAG CTGTCCAATGGCAACAGGACCCTCACTCTATTCAATGTCACAAGAAATGA CGCAAGAGCCTATGTATGTGGAATCCAGAACTCAGTGAGTGCAAACCGCA GTGACCCAGTCACCCTGGATGTCCTCTATGGGCCGGACACCCCCATCATT TCCCCCCCAGACTCGTCTTACCTTTCGGGAGCGGACCTCAACCTCTCCTG CCACTCGGCCTCTAACCCATCCCCGCAGTATTCTTGGCGTATCAATGGGA TACCGCAGCAACACACACAAGTTCTCTTTATCGCCAAAATCACGCCAAAT AATAACGGGACCTATGCCTGTTTTGTCTCTAACTTGGCTACTGGCCGCAA TAATTCCATAGTCAAGAGCATCACAGTCTCTGCATCTGGAACTTCTCCTG GTCTCTCAGCTGGGGCCACTGTCGGCATCATGATTGGAGTGCTGGTTGGG GTTGCTCTGATATAGCAGCCCTGGTGTAGTTTCTTCATTTCAGGAAGACT GACAGTTGTTTTGCTTCTTCCTTAAAGCATTTGCAACAGCTACAGTCTAA AATTGCTTCTTTACCAAGGATATTTACAGAAAAGACTCTGACCAGAGATC GAGACCATCCTCTAGATAAGATATCCGATCCACCGGATCTAGATAACTGA TCATAATCAGCCATACCACATTTGTAGAGGTTTTACTTGCTTTAAAAAAC CTCCCACACCTCCCCCTGAACCTGAAACATAAAATGAATGCAATTGTTGT TGTTAACTTGTTTATTGCAGCTTATAATGGTTACAAATAAAGCAATAGCA TCACAAATTTCACAAATAAAGCATTTTTTTCACTGCATTCTAGTTGTGGT TTGTCCAAACTCATCAATGTATCTTAACGCGGATCTGGGCGTGGTTAAGG GTGGGAAAGAATATATAAGGTGGGGGTCTTATGTAGTTTTGTATCTGTTT TGCAGCAGCCGCCGCCGCCATGAGCACCAACTCGTTTGATGGAAGCATTG TGAGCTCATATTTGACAACGCGCATGCCCCCATGGGCCGGGGTGCGTCAG AATGTGATGGGCTCCAGCATTGATGGTCGCCCCGTCCTGCCCGCAAACTC TACTACCTTGACCTACGAGACCGTGTCTGGAACGCCGTTGGAGACTGCAG CCTCCGCCGCCGCTTCAGCCGCTGCAGCCACCGCCCGCGGGATTGTGACT GACTTTGCTTTCCTGAGCCCGCTTGCAAGCAGTGCAGCTTCCCGTTCATC CGCCCGCGATGACAAGTTGACGGCTCTTTTGGCACAATTGGATTCTTTGA CCCGGGAACTTAATGTCGTTTCTCAGCAGCTGTTGGATCTGCGCCAGCAG GTTTCTGCCCTGAAGGCTTCCTCCCCTCCCAATGCGGTTTAAAACATAAA TAAAAAACCAGACTCTGTTTGGATTTGGATCAAGCAAGTGTCTTGCTGTC TTTATTTAGGGGTTTTGCGCGCGCGGTAGGCCCGGGACCAGCGGTCTCGG TCGTTGAGGGTCCTGTGTATTTTTTCCAGGACGTGGTAAAGGTGACTCTG GATGTTCAGATACATGGGCATAAGCCCGTCTCTGGGGTGGAGGTAGCACC ACTGCAGAGCTTCATGCTGCGGGGTGGTGTTGTAGATGATCCAGTCGTAG CAGGAGCGCTGGGCGTGGTGCCTAAAAATGTCTTTCAGTAGCAAGCTGAT TGCCAGGGGCAGGCCCTTGGTGTAAGTGTTTACAAAGCGGTTAAGCTGGG ATGGGTGCATACGTGGGGATATGAGATGCATCTTGGACTGTATTTTTAGG TTGGCTATGTTCCCAGCCATATCCCTCCGGGGATTCATGTTGTGCAGAAC CACCAGCACAGTGTATCCGGTGCACTTGGGAAATTTGTCATGTAGCTTAG AAGGAAATGCGTGGAAGAACTTGGAGACGCCCTTGTGACCTCCAAGATTT TCCATGCATTCGTCCATAATGATGGCAATGGGCCCACGGGCGGCGGCCTG GGCGAAGATATTTCTGGGATCACTAACGTCATAGTTGTGTTCCAGGATGA GATCGTCATAGGCCATTTTTACAAAGCGCGGGCGGAGGGTGCCAGACTGC GGTATAATGGTTCCATCCGGCCCAGGGGCGTAGTTACCCTCACAGATTTG CATTTCCCACGCTTTGAGTTCAGATGGGGGGATCATGTCTACCTGCGGGG CGATGAAGAAAACGGTTTCCGGGGTAGGGGAGATCAGCTGGGAAGAAAGC AGGTTCCTGAGCAGCTGCGACTTACCGCAGCCGGTGGGCCCGTAAATCAC ACCTATTACCGGCTGCAACTGGTAGTTAAGAGAGCTGCAGCTGCCGTCAT CCCTGAGCAGGGGGGCCACTTCGTTAAGCATGTCCCTGACTCGCATGTTT TCCCTGACCAAATCCGCCAGAAGGCGCTCGCCGCCCAGCGATAGCAGTTC TTGCAAGGAAGCAAAGTTTTTCAACGGTTTGAGACCGTCCGCCGTAGGCA TGCTTTTGAGCGTTTGACCAAGCAGTTCCAGGCGGTCCCACAGCTCGGTC ACCTGCTCTACGGCATCTCGATCCAGCATATCTCCTCGTTTCGCGGGTTG GGGCGGCTTTCGCTGTACGGCAGTAGTCGGTGCTCGTCCAGACGGGCCAG GGTCATGTCTTTCCACGGGCGCAGGGTCCTCGTCAGCGTAGTCTGGGTCA CGGTGAAGGGGTGCGCTCCGGGCTGCGCGCTGGCCAGGGTGCGCTTGAGG CTGGTCCTGCTGGTGCTGAAGCGCTGCCGGTCTTCGCCCTGCGCGTCGGC CAGGTAGCATTTGACCATGGTGTCATAGTCCAGCCCCTCCGCGGCGTGGC CCTTGGCGCGCAGCTTGCCCTTGGAGGAGGCGCCGCACGAGGGGCAGTGC AGACTTTTGAGGGCGTAGAGCTTGGGCGCGAGAAATACCGATTCCGGGGA GTAGGCATCCGCGCCGCAGGCCCCGCAGACGGTCTCGCATTCCACGAGCC AGGTGAGCTCTGGCCGTTCGGGGTCAAAAACCAGGTTTCCCCCATGCTTT TTGATGCGTTTCTTACCTCTGGTTTCCATGAGCCGGTGTCCACGCTCGGT GACGAAAAGGCTGTCCGTGTCCCCGTATACAGACTTGAGAGGCCTGTCCT CGAGCGGTGTTCCGCGGTCCTCCTCGTATAGAAACTCGGACCACTCTGAG ACAAAGGCTCGCGTCCAGGCCAGCACGAAGGAGGCTAAGTGGGAGGGGTA GCGGTCGTTGTCCACTAGGGGGTCCACTCGCTCCAGGGTGTGAAGACACA TGTCGCCCTCTTCGGCATCAAGGAAGGTGATTGGTTTGTAGGTGTAGGCC ACGTGACCGGGTGTTCCTGAAGGGGGGCTATAAAAGGGGGTGGGGGCGCG TTCGTCCTCACTCTCTTCCGCATCGCTGTCTGCGAGGGCCAGCTGTTGGG GTGAGTACTCCCTCTGAAAAGCGGGCATGACTTCTGCGCTAAGATTGTCA GTTTCCAAAAACGAGGAGGATTTGATATTCACCTGGCCCGCGGTGATGCC TTTGAGGGTGGCCGCATCCATCTGGTCAGAAAAGACAATCTTTTTGTTGT CAAGCTTGGTGGCAAACGACCCGTAGAGGGCGTTGGACAGCAACTTGGCG ATGGAGCGCAGGGTTTGGTTTTTGTCGCGATCGGCGCGCTCCTTGGCCGC GATGTTTAGCTGCACGTATTCGCGCGCAACGCACCGCCATTCGGGAAAGA CGGTGGTGCGCTCGTCGGGCACCAGGTGCACGCGCCAACCGCGGTTGTGC AGGGTGACAAGGTCAACGCTGGTGGCTACCTCTCCGCGTAGGCGCTCGTT GGTCCAGCAGAGGCGGCCGCCCTTGCGCGAGCAGAATGGCGGTAGGGGGT CTAGCTGCGTCTCGTCCGGGGGGTCTGCGTCCACGGTAAAGACCCCGGGC AGCAGGCGCGCGTCGAAGTAGTCTATCTTGCATCCTTGCAAGTCTAGCGC CTGCTGCCATGCGCGGGCGGCAAGCGCGCGCTCGTATGGGTTGAGTGGGG GACCCCATGGCATGGGGTGGGTGAGCGCGGAGGCGTACATGCCGCAAATG TCGTAAACGTAGAGGGGCTCTCTGAGTATTCCAAGATATGTAGGGTAGCA TCTTCCACCGCGGATGCTGGCGCGCACGTAATCGTATAGTTCGTGCGAGG GAGCGAGGAGGTCGGGACCGAGGTTGCTACGGGCGGGCTGCTCTGCTCGG AAGACTATCTGCCTGAAGATGGCATGTGAGTTGGATGATATGGTTGGACG CTGGAAGACGTTGAAGCTGGCGTCTGTGAGACCTACCGCGTCACGCACGA AGGAGGCGTAGGAGTCGCGCAGCTTGTTGACCAGCTCGGCGGTGACCTGC ACGTCTAGGGCGCAGTAGTCCAGGGTTTCCTTGATGATGTCATACTTATC CTGTCCCTTTTTTTTCCACAGCTCGCGGTTGAGGACAAACTCTTCGCGGT CTTTCCAGTACTCTTGGATCGGAAACCCGTCGGCCTCCGAACGGTAAGAG CCTAGCATGTAGAACTGGTTGACGGCCTGGTAGGCGCAGCATCCCTTTTC TACGGGTAGCGCGTATGCCTGCGCGGCCTTCCGGCATGACCAGCATGAAG GGCACGAGCTGCTTCCCAAAGGCCCCCATCCAAGTATAGGTCTCTACATC GTAGGTGACAAAGAGACGCTCGGTGCGAGGATGCGAGCCGATCGGGAAGA ACTGGATCTCCCGCCACCAATTGGAGGAGTGGCTATTGATGTGGTGAAAG TAGAAGTCCCTGCGACGGGCCGAACACTCGTGCTGGCTTTTGTAAAAACG TGCGCAGTACTGGCAGCGGTGCACGGGCTGTACATCCTGCACGAGGTTGA CCTGACGACCGCGCACAAGGAAGCAGAGTGGGAATTTGAGCCCCTCGCCT GGCGGGTTTGGCTGGTGGTCTTCTACTTCGGCTGCTTGTCCTTGACCGTC TGGCTGCTCGAGGGGAGTTACGGTGGATCGGACCACCACGCCGCGCGAGC CCAAAGTCCAGATGTCCGCGCGCGGCGGTCGGAGCTTGATGACAACATCG CGCAGATGGGAGCTGTCCATGGTCTGGAGCTCCCGCGGCGTCAGGTCAGG CGGGAGCTCCTGCAGGTTTACCTCGCATAGACGGGTCAGGGCGCGGGCTA GATCCAGGTGATACCTAATTTCCAGGGGCTGGTTGGTGGCGGCGTCGATG GCTTGCAAGAGGCCGCATCCCCGCGGCGCGACTACGGTACCGCGCGGCGG GCGGTGGGCCGCGGGGGTGTCCTTGGATGATGCATCTAAAAGCGGTGACG CGGGCGAGCCCCCGGAGGTAGGGGGGGCTCCGGACCCGCCGGGAGAGGGG GCAGGGGCACGTCGGCGCCGCGCGCGGGCAGGAGCTGGTGCTGCGCGCGT AGGTTGCTGGCGAACGCGACGACGCGGCGGTTGATCTCCTGAATCTGGCG CCTCTGCGTGAAGACGACGGGCCCGGTGAGCTTGAACCTGAAAGAGAGTT CGACAGAATCAATTTCGGTGTCGTTGACGGCGGCCTGGCGCAAAATCTCC TGCACGTCTCCTGAGTTGTCTTGATAGGCGATCTCGGCCATGAACTGCTC GATCTCTTCCTCCTGGAGATCTCCGCGTCCGGCTCGCTCCACGGTGGCGG CGAGGTCGTTGGAAATGCGGGCCATGAGCTGCGAGAAGGCGTTGAGGCCT CCCTCGTTCCAGACGCGGCTGTAGACCACGCCCCCTTCGGCATCGCGGGC GCGCATGACCACCTGCGCGAGATTGAGCTCCACGTGCCGGGCGAAGACGG CGTAGTTTCGCAGGCGCTGAAAGAGGTAGTTGAGGGTGGTGGCGGTGTGT TCTGCCACGAAGAAGTACATAACCCAGCGTCGCAACGTGGATTCGTTGAT AATTGTTGTGTAGGTACTCCGCCGCCGAGGGACCTGAGCGAGTCCGCATC GACCGGATCGGAAAACCTCTCGAGAAAGGCGTCTAACCAGTCACAGTCGC AAGGTAGGCTGAGCACCGTGGCGGGCGGCAGCGGGCGGCGGTCGGGGTTG TTTCTGGCGGAGGTGCTGCTGATGATGTAATTAAAGTAGGCGGTCTTGAG ACGGCGGATGGTCGACAGAAGCACCATGTCCTTGGGTCCGGCCTGCTGAA TGCGCAGGCGGTCGGCCATGCCCCAGGCTTCGTTTTGACATCGGCGCAGG TCTTTGTAGTAGTCTTGCATGAGCCTTTCTACCGGCACTTCTTCTTCTCC TTCCTCTTGTCCTGCATCTCTTGCATCTATCGCTGCGGCGGCGGCGGAGT TTGGCCGTAGGTGGCGCCCTCTTCCTCCCATGCGTGTGACCCCGAAGCCC CTCATCGGCTGAAGCAGGGCTAGGTCGGCGACAACGCGCTCGGCTAATAT GGCCTGCTGCACCTGCGTGAGGGTAGACTGGAAGTCATCCATGTCCACAA AGCGGTGGTATGCGCCCGTGTTGATGGTGTAAGTGCAGTTGGCCATAACG GACCAGTTAACGGTCTGGTGACCCGGCTGCGAGAGCTCGGTGTACCTGAG ACGCGAGTAAGCCCTCGAGTCAAATACGTAGTCGTTGCAAGTCCGCACCA GGTACTGGTATCCCACCAAAAAGTGCGGCGGCGGCTGGCGGTAGAGGGGC CAGCGTAGGGTGGCCGGGGCTCCGGGGGCGAGATCTTCCAACATAAGGCG ATGATATCCGTAGATGTACCTGGACATCCAGGTGATGCCGGCGGCGGTGG TGGAGGCGCGCGGAAAGTCGCGGACGCGGTTCCAGATGTTGCGCAGCGGC AAAAAGTGCTCCATGGTCGGGACGCTCTGGCCGGTCAGGCGCGCGCAATC GTTGACGCTCTAGCGTGCAAAAGGAGAGCCTGTAAGCGGGCACTCTTCCG TGGTCTGGTGGATAAATTCGCAAGGGTATCATGGCGGACGACCGGGGTTC GAGCCCCGTATCCGGCCGTCCGCCGTGATCCATGCGGTTACCGCCCGCGT GTCGAACCCAGGTGTGCGACGTCAGACAACGGGGGAGTGCTCCTTTTGGC TTCCTTCCAGGCGCGGCGGCTGCTGCGCTAGCTTTTTTGGCCACTGGCCG CGCGCAGCGTAAGCGGTTAGGCTGGAAAGCGAAAGCATTAAGTGGCTCGC TCCCTGTAGCCGGAGGGTTATTTTCCAAGGGTTGAGTCGCGGGACCCCCG GTTCGAGTCTCGGACCGGCCGGACTGCGGCGAACGGGGGTTTGCCTCCCC GTCATGCAAGACCCCGCTTGCAAATTCCTCCGGAAACAGGGACGAGCCCC TTTTTTGCTTTTCCCAGATGCATCCGGTGCTGCGGCAGATGCGCCCCCCT CCTCAGCAGCGGCAAGAGCAAGAGCAGCGGCAGACATGCAGGGCACCCTC CCCTCCTCCTACCGCGTCAGGAGGGGCGACATCCGCGGTTGACGCGGCAG CAGATGGTGATTACGAACCCCCGCGGCGCCGGGCCCGGCACTACCTGGAC TTGGAGGAGGGCGAGGGCCTGGCGCGGCTAGGAGCGCCCTCTCCTGAGCG GCACCCAAGGGTGCAGCTGAAGCGTGATACGCGTGAGGCGTACGTGCCGC GGCAGAACCTGTTTCGCGACCGCGAGGGAGAGGAGCCCGAGGAGATGCGG GATCGAAAGTTCCACGCAGGGCGCGAGCTGCGGCATGGCCTGAATCGCGA GCGGTTGCTGCGCGAGGAGGACTTTGAGCCCGACGCGCGAACCGGGATTA GTCCCGCGCGCGCACACGTGGCGGCCGCCGACCTGGTAACCGCATACGAG CAGACGGTGAACCAGGAGATTAACTTTCAAAAAAGCTTTAACAACCACGT GCGTACGCTTGTGGCGCGCGAGGAGGTGGCTATAGGACTGATGCATCTGT GGGACTTTGTAAGCGCGCTGGAGCAAAACCCAAATAGCAAGCCGCTCATG GCGCAGCTGTTCCTTATAGTGCAGCACAGCAGGGACAACGAGGCATTCAG GGATGCGCTGCTAAACATAGTAGAGCCCGAGGGCCGCTGGCTGCTCGATT TGATAAACATCCTGCAGAGCATAGTGGTGCAGGAGCGCAGCTTGAGCCTG GCTGACAAGGTGGCCGCCATCAACTATTCCATGCTTAGCCTGGGCAAGTT TTACGCCCGCAAGATATACCATACCCCTTACGTTCCCATAGACAAGGAGG TAAAGATCGAGGGGTTCTACATGCGCATGGCGCTGAAGGTGCTTACCTTG AGCGACGACCTGGGCGTTTATCGCAACGAGCGCATCCACAAGGCCGTGAG CGTGAGCCGGCGGCGCGAGCTCAGCGACCGCGAGCTGATGCACAGCCTGC AAAGGGCCCTGGCTGGCACGGGCAGCGGCGATAGAGAGGCCGAGTCCTAC TTTGACGCGGGCGCTGACCTGCGCTGGGCCCCAAGCCGACGCGCCCTGGA GGCAGCTGGGGCCGGACCTGGGCTGGCGGTGGCACCCGCGCGCGCTGGCA ACGTCGGCGGCGTGGAGGAATATGACGAGGACGATGAGTACGAGCCAGAG GACGGCGAGTACTAAGCGGTGATGTTTCTGATCAGATGATGCAAGACGCA ACGGACCCGGCGGTGCGGGCGGCGCTGCAGAGCCAGCCGTCCGGCCTTAA CTCCACGGACGACTGGCGCCAGGTCATGGACCGCATCATGTCGCTGACTG CGCGCAATCCTGACGCGTTCCGGCAGCAGCCGCAGGCCAACCGGCTCTCC GCAATTCTGGAAGCGGTGGTCCCGGCGCGCGCAAACCCCACGCACGAGAA GGTGCTGGCGATCGTAAACGCGCTGGCCGAAAACAGGGCCATCCGGCCCG ACGAGGCCGGCCTGGTCTACGACGCGCTGCTTCAGCGCGTGGCTCGTTAC AACAGCGGCAACGTGCAGACCAACCTGGACCGGCTGGTGGGGGATGTGCG CGAGGCCGTGGCGCAGCGTGAGCGCGCGCAGCAGCAGGGCAACCTGGGCT CCATGGTTGCACTAAACGCCTTCCTGAGTACACAGCCCGCCAACGTGCCG CGGGGACAGGAGGACTACACCAACTTTGTGAGCGCACTGCGGCTAATGGT GACTGAGACACCGCAAAGTGAGGTGTACCAGTCTGGGCCAGACTATTTTT TCCAGACCAGTAGACAAGGCCTGCAGACCGTAAACCTGAGCCAGGCTTTC AAAAACTTGCAGGGGCTGTGGGGGGTGCGGGCTCCCACAGGCGACCGCGC GACCGTGTCTAGCTTGCTGACGCCCAACTCGCGCCTGTTGCTGCTGCTAA TAGCGCCCTTCACGGACAGTGGCAGCGTGTCCCGGGACACATACCTAGGT CACTTGCTGACACTGTACCGCGAGGCCATAGGTCAGGCGCATGTGGACGA GCATACTTTCCAGGAGATTACAAGTGTCAGCCGCGCGCTGGGGCAGGAGG ACACGGGCAGCCTGGAGGCAACCCTAAACTACCTGCTGACCAACCGGCGG CAGAAGATCCCCTCGTTGCACAGTTTAAACAGCGAGGAGGAGCGCATTTT GCGCTACGTGCAGCAGAGCGTGAGCCTTAACCTGATGCGCGACGGGGTAA CGCCCAGCGTGGCGCTGGACATGACCGCGCGCAACATGGAACCGGGCATG TATGCCTCAAACCGGCCGTTTATCAACCGCCTAATGGACTACTTGCATCG CGCGGCCGCCGTGAACCCCGAGTATTTCACCAATGCCATCTTGAACCCGC ACTGGCTACCGCCCCCTGGTTTCTACACCGGGGGATTCGAGGTGCCCGAG GGTAACGATGGATTCCTCTGGGACGACATAGACGACAGCGTGTTTTCCCC GCAACCGCAGACCCTGCTAGAGTTGCAACAGCGCGAGCAGGCAGAGGCGG CGCTGCGAAAGGAAAGCTTCCGCAGGCCAAGCAGCTTGTCCGATCTAGGC GCTGCGGCCCCGCGGTCAGATGCTAGTAGCCCATTTCCAAGCTTGATAGG GTCTCTTACCAGCACTCGCACCACCCGCCCGCGCCTGCTGGGCGAGGAGG AGTACCTAAACAACTCGCTGCTGCAGCCGCAGCGCGAAAAAAACCTGCCT CCGGCATTTCCCAACAACGGGATAGAGAGCCTAGTGGACAAGATGAGTAG ATGGAAGACGTACGCGCAGGAGCACAGGGACGTGCCAGGCCCGCGCCCGC CCACCCGTCGTCAAAGGCACGACCGTCAGCGGGGTCTGGTGTGGGAGGAC GATGACTCGGCAGACGACAGCAGCGTCCTGGATTTGGGAGGGAGTGGCAA CCCGTTTGCGCACCTTCGCCCCAGGCTGGGGAGAATGTTTTAAAAAAAAA AAAGCATGATGCAAAATAAAAAACTCACCAAGGCCATGGCACCGAGCGTT GGTTTTCTTGTATTCCCCTTAGTATGCGGCGCGCGGCGATGTATGAGGAA GGTCCTCCTCCCTCCTACGAGAGTGTGGTGAGCGCGGCGCCAGTGGCGGC GGCGCTGGGTTCTCCCTTCGATGCTCCCCTGGACCCGCCGTTTGTGCCTC CGCGGTACCTGCGGCCTACCGGGGGGAGAAACAGCATCCGTTACTCTGAG TTGGCACCCCTATTCGACACCACCCGTGTGTACCTGGTGGACAACAAGTC AACGGATGTGGCATCCCTGAACTACCAGAACGACCACAGCAACTTTCTGA CCACGGTCATTCAAAACAATGACTACAGCCCGGGGGAGGCAAGCACACAG ACCATCAATCTTGACGACCGGTCGCACTGGGGCGGCGACCTGAAAACCAT CCTGCATACCAACATGCCAAATGTGAACGAGTTCATGTTTACCAATAAGT TTAAGGCGCGGGTGATGGTGTCGCGCTTGCCTACTAAGGACAATCAGGTG GAGCTGAAATACGAGTGGGTGGAGTTCACGCTGCCCGAGGGCAACTACTC CGAGACCATGACCATAGACCTTATGAACAACGCGATCGTGGAGCACTACT TGAAAGTGGGCAGACAGAACGGGGTTCTGGAAAGCGACATCGGGGTAAAG TTTGACACCCGCAACTTCAGACTGGGGTTTGACCCCGTCACTGGTCTTGT CATGCCTGGGGTATATACAAACGAAGCCTTCCATCCAGACATCATTTTGC TGCCAGGATGCGGGGTGGACTTCACCCACAGCCGCCTGAGCAACTTGTTG GGCATCCGCAAGCGGCAACCCTTCCAGGAGGGCTTTAGGATCACCTACGA TGATCTGGAGGGTGGTAACATTCCCGCACTGTTGGATGTGGACGCCTACC AGGCGAGCTTGAAAGATGACACCGAACAGGGCGGGGGTGGCGCAGGCGGC AGCAACAGCAGTGGCAGCGGCGCGGAAGAGAACTCCAACGCGGCAGCCGC GGCAATGCAGCCGGTGGAGGACATGAACGATCATGCCATTCGCGGCGACA CCTTTGCCACACGGGCTGAGGAGAAGCGCGCTGAGGCCGAAGCAGCGGCC GAAGCTGCCGCCCCCGCTGCGCAACCCGAGGTCGAGAAGCCTCAGAAGAA ACCGGTGATCAAACCCCTGACAGAGGACAGCAAGAAACGCAGTTACAACC TAATAAGCAATGACAGCACCTTCACCCAGTACCGCAGCTGGTACCTTGCA TACAACTACGGCGACCCTCAGACCGGAATCCGCTCATGGACCCTGCTTTG CACTCCTGACGTAACCTGCGGCTCGGAGCAGGTCTACTGGTCGTTGCCAG ACATGATGCAAGACCCCGTGACCTTCCGCTCCACGCGCCAGATCAGCAAC TTTCCGGTGGTGGGCGCCGAGCTGTTGCCCGTGCACTCCAAGAGCTTCTA CAACGACCAGGCCGTCTACTCCCAACTCATCCGCCAGTTTACCTCTCTGA CCCACGTGTTCAATCGCTTTCCCGAGAACCAGATTTTGGCGCGCCCGCCA GCCCCCACCATCACCACCGTCAGTGAAAACGTTCCTGCTCTCACAGATCA CGGGACGCTACCGCTGCGCAACAGCATCGGAGGAGTCCAGCGAGTGACCA TTACTGACGCCAGACGCCGCACCTGCCCCTACGTTTACAAGGCCCTGGGC ATAGTCTCGCCGCGCGTCCTATCGAGCCGCACTTTTTGAGCAAGCATGTC CATCCTTATATCGCCCAGCAATAACACAGGCTGGGGCCTGCGCTTCCCAA GCAAGATGTTTGGCGGGGCCAAGAAGCGCTCCGACCAACACCCAGTGCGC GTGCGCGGGCACTACCGCGCGCCCTGGGGCGCGCACAAACGCGGCCGCAC TGGGCGCACCACCGTCGATGACGCCATCGACGCGGTGGTGGAGGAGGCGC GCAACTACACGCCCACGCCGCCACCAGTGTCCACAGTGGACGCGGCCATT CAGACCGTGGTGCGCGGAGCCCGGCGCTATGCTAAAATGAAGAGACGGCG GAGGCGCGTAGCACGTCGCCACCGCCGCCGACCCGGCACTGCCGCCCAAC GCGCGGCGGCGGCCCTGCTTAACCGCGCACGTCGCACCGGCCGACGGGCG GCCATGCGGGCCGCTCGAAGGCTGGCCGCGGGTATTGTCACTGTGCCCCC CAGGTCCAGGCGACGAGCGGCCGCCGCAGCAGCCGCGGCCATTAGTGCTA TGACTCAGGGTCGCAGGGGCAACGTGTATTGGGTGCGCGACTCGGTTAGC GGCCTGCGCGTGCCCGTGCGCACCCGCCCCCCGCGCAACTAGATTGCAAG AAAAAACTACTTAGACTCGTACTGTTGTATGTATCCAGCGGCGGCGGCGC GCAACGAAGCTATGTCCAAGCGCAAAATCAAAGAAGAGATGCTCCAGGTC ATCGCGCCGGAGATCTATGGCCCCCCGAAGAAGGAAGAGCAGGATTACAA GCCCCGAAAGCTAAAGCGGGTCAAAAAGAAAAAGAAAGATGATGATGATG AACTTGACGACGAGGTGGAACTGCTGCACGCTACCGCGCCCAGGCGACGG GTACAGTGGAAAGGTCGACGCGTAAAACGTGTTTTGCGACCCGGCACCAC CGTAGTCTTTACGCCCGGTGAGCGCTCCACCCGCACCTACAAGCGCGTGT ATGATGAGGTGTACGGCGACGAGGACCTGCTTGAGCAGGCCAACGAGCGC CTCGGGGAGTTTGCCTACGGAAAGCGGCATAAGGACATGCTGGCGTTGCC GCTGGACGAGGGCAACCCAACACCTAGCCTAAAGCCCGTAACACTGCAGC AGGTGCTGCCCGCGCTTGCACCGTCCGAAGAAAAGCGCGGCCTAAAGCGC GAGTCTGGTGACTTGGCACCCACCGTGCAGCTGATGGTACCCAAGCGCCA GCGACTGGAAGATGTCTTGGAAAAAATGACCGTGGAACCTGGGCTGGAGC CCGAGGTCCGCGTGCGGCCAATCAAGCAGGTGGCGCCGGGACTGGGCGTG CAGACCGTGGACGTTCAGATACCCACTACCAGTAGCACCAGTATTGCCAC CGCCACAGAGGGCATGGAGACACAAACGTCCCCGGTTGCCTCAGCGGTGG CGGATGCCGCGGTGCAGGCGGTCGCTGCGGCCGCGTCCAAGACCTCTACG GAGGTGCAAACGGACCCGTGGATGTTTCGCGTTTCAGCCCCCCGGCGCCC GCGCCGTTCGAGGAAGTACGGCGCCGCCAGCGCGCTACTGCCCGAATATG CCCTACATCCTTCCATTGCGCCTACCCCCGGCTATCGTGGCTACACCTAC CGCCCCAGAAGACGAGCAACTACCCGACGCCGAACCACCACTGGAACCCG CCGCCGCCGTCGCCGTCGCCAGCCCGTGCTGGCCCCGATTTCCGTGCGCA GGGTGGCTCGCGAAGGAGGCAGGACCCTGGTGCTGCCAACAGCGCGCTAC CACCCCAGCATCGTTTAAAAGCCGGTCTTTGTGGTTCTTGCAGATATGGC CCTCACCTGCCGCCTCCGTTTCCCGGTGCCGGGATTCCGAGGAAGAATGC ACCGTAGGAGGGGCATGGCCGGCCACGGCCTGACGGGCGGCATGCGTCGT GCGCACCACCGGCGGCGGCGCGCGTCGCACCGTCGCATGCGCGGCGGTAT CCTGCCCCTCCTTATTCCACTGATCGCCGCGGCGATTGGCGCCGTGCCCG GAATTGCATCCGTGGCCTTGCAGGCGCAGAGACACTGATTAAAAACAAGT TGCATGTGGAAAAATCAAAATAAAAAGTCTGGACTCTCACGCTCGCTTGG TCCTGTAACTATTTTGTAGAATGGAAGACATCAACTTTGCGTCTCTGGCC CCGCGACACGGCTCGCGCCCGTTCATGGGAAACTGGCAAGATATCGGCAC CAGCAATATGAGCGGTGGCGCCTTCAGCTGGGGCTCGCTGTGGAGCGGCA TTAAAAATTTCGGTTCCACCGTTAAGAACTATGGCAGCAAGGCCTGGAAC AGCAGCACAGGCCAGATGCTGAGGGATAAGTTGAAAGAGCAAAATTTCCA ACAAAAGGTGGTAGATGGCCTGGCCTCTGGCATTAGCGGGGTGGTGGACC TGGCCAACCAGGCAGTGCAAAATAAGATTAACAGTAAGCTTGATCCCCGC CCTCCCGTAGAGGAGCCTCCACCGGCCGTGGAGACAGTGTCTCCAGAGGG GCGTGGCGAAAAGCGTCCGCGCCCCGACAGGGAAGAAACTCTGGTGACGC AAATAGACGAGCCTCCCTCGTACGAGGAGGCACTAAAGCAAGGCCTGCCC ACCACCCGTCCCATCGCGCCCATGGCTACCGGAGTGCTGGGCCAGCACAC ACCCGTAACGCTGGACCTGCCTCCCCCCGCCGACACCCAGCAGAAACCTG TGCTGCCAGGCCCGACCGCCGTTGTTGTAACCCGTCCTAGCCGCGCGTCC CTGCGCCGCGCCGCCAGCGGTCCGCGATCGTTGCGGCCCGTAGCCAGTGG CAACTGGCAAAGCACACTGAACAGCATCGTGGGTCTGGGGGTGCAATCCC TGAAGCGCCGACGATGCTTCTGATAGCTAACGTGTCGTATGTGTGTCATG TATGCGTCCATGTCGCCGCCAGAGGAGCTGCTGAGCCGCCGCGCGCCCGC TTTCCAAGATGGCTACCCCTTCGATGATGCCGCAGTGGTCTTACATGCAC ATCTCGGGCCAGGACGCCTCGGAGTACCTGAGCCCCGGGCTGGTGCAGTT TGCCCGCGCCACCGAGACGTACTTCAGCCTGAATAACAAGTTTAGAAACC CCACGGTGGCGCCTACGCACGACGTGACCACAGACCGGTCCCAGCGTTTG ACGCTGCGGTTCATCCCTGTGGACCGTGAGGATACTGCGTACTCGTACAA GGCGCGGTTCACCCTAGCTGTGGGTGATAACCGTGTGCTGGACATGGCTT CCACGTACTTTGACATCCGCGGCGTGCTGGACAGGGGCCCTACTTTTAAG CCCTACTCTGGCACTGCCTACAACGCCCTGGCTCCCAAGGGTGCCCCAAA TCCTTGCGAATGGGATGAAGCTGCTACTGCTCTTGAAATAAACCTAGAAG AAGAGGACGATGACAACGAAGACGAAGTAGACGAGCAAGCTGAGCAGCAA AAAACTCACGTATTTGGGCAGGCGCCTTATTCTGGTATAAATATTACAAA GGAGGGTATTCAAATAGGTGTCGAAGGTCAAACACCTAAATATGCCGATA AAACATTTCAACCTGAACCTCAAATAGGAGAATCTCAGTGGTACGAAACA GAAATTAATCATGCAGCTGGGAGAGTCCTAAAAAAGACTACCCCAATGAA ACCATGTTACGGTTCATATGCAAAACCCACAAATGAAAATGGAGGGCAAG GCATTCTTGTAAAGCAACAAAATGGAAAGCTAGAAAGTCAAGTGGAAATG CAATTTTTCTCAACTACTGAGGCAGCCGCAGGCAATGGTGATAACTTGAC TCCTAAAGTGGTATTGTACAGTGAAGATGTAGATATAGAAACCCCAGACA CTCATATTTCTTACATGCCCACTATTAAGGAAGGTAACTCACGAGAACTA ATGGGCCAACAATCTATGCCCAACAGGCCTAATTACATTGCTTTTAGGGA CAATTTTATTGGTCTAATGTATTACAACAGCACGGGTAATATGGGTGTTC TGGCGGGCCAAGCATCGCAGTTGAATGCTGTTGTAGATTTGCAAGACAGA AACACAGAGCTTTCATACCAGCTTTTGCTTGATTCCATTGGTGATAGAAC CAGGTACTTTTCTATGTGGAATCAGGCTGTTGACAGCTATGATCCAGATG TTAGAATTATTGAAAATCATGGAACTGAAGATGAACTTCCAAATTACTGC TTTCCACTGGGAGGTGTGATTAATACAGAGACTCTTACCAAGGTAAAACC TAAAACAGGTCAGGAAAATGGATGGGAAAAAGATGCTACAGAATTTTCAG ATAAAAATGAAATAAGAGTTGGAAATAATTTTGCCATGGAAATCAATCTA AATGCCAACCTGTGGAGAAATTTCCTGTACTCCAACATAGCGCTGTATTT GCCCGACAAGCTAAAGTACAGTCCTTCCAACGTAAAAATTTCTGATAACC CAAACACCTACGACTACATGAACAAGCGAGTGGTGGCTCCCGGGCTAGTG GACTGCTACATTAACCTTGGAGCACGCTGGTCCCTTGACTATATGGACAA CGTCAACCCATTTAACCACCACCGCAATGCTGGCCTGCGCTACCGCTCAA TGTTGCTGGGCAATGGTCGCTATGTGCCCTTCCACATCCAGGTGCCTCAG AAGTTCTTTGCCATTAAAAACCTCCTTCTCCTGCCGGGCTCATACACCTA CGAGTGGAACTTCAGGAAGGATGTTAACATGGTTCTGCAGAGCTCCCTAG GAAATGACCTAAGGGTTGACGGAGCCAGCATTAAGTTTGATAGCATTTGC CTTTACGCCACCTTCTTCCCCATGGCCCACAACACCGCCTCCACGCTTGA GGCCATGCTTAGAAACGACACCAACGACCAGTCCTTTAACGACTATCTCT CCGCCGCCAACATGCTCTACCCTATACCCGCCAACGCTACCAACGTGCCC ATATCCATCCCCTCCCGCAACTGGGCGGCTTTCCGCGGCTGGGCCTTCAC GCGCCTTAAGACTAAGGAAACCCCATCACTGGGCTCGGGCTACGACCCTT ATTACACCTACTCTGGCTCTATACCCTACCTAGATGGAACCTTTTACCTC AACCACACCTTTAAGAAGGTGGCCATTACCTTTGACTCTTCTGTCAGCTG GCCTGGCAATGACCGCCTGCTTACCCCCAACGAGTTTGAAATTAAGCGCT CAGTTGACGGGGAGGGTTACAACGTTGCCCAGTGTAACATGACCAAAGAC TGGTTCCTGGTACAAATGCTAGCTAACTATAACATTGGCTACCAGGGCTT CTATATCCCAGAGAGCTACAAGGACCGCATGTACTCCTTCTTTAGAAACT TCCAGCCCATGAGCCGTCAGGTGGTGGATGATACTAAATACAAGGACTAC CAACAGGTGGGCATCCTACACCAACACAACAACTCTGGATTTGTTGGCTA CCTTGCCCCCACCATGCGCGAAGGACAGGCCTACCCTGCTAACTTCCCCT ATCCGCTTATAGGCAAGACCGCAGTTGACAGCATTACCCAGAAAAAGTTT CTTTGCGATCGCACCCTTTGGCGCATCCCATTCTCCAGTAACTTTATGTC CATGGGCGCACTCACAGACCTGGGCCAAAACCTTCTCTACGCCAACTCCG CCCACGCGCTAGACATGACTTTTGAGGTGGATCCCATGGACGAGCCCACC CTTCTTTATGTTTTGTTTGAAGTCTTTGACGTGGTCCGTGTGCACCAGCC GCACCGCGGCGTCATCGAAACCGTGTACCTGCGCACGCCCTTCTCGGCCG GCAACGCCACAACATAAAGAAGCAAGCAACATCAACAACAGCTGCCGCCA TGGGCTCCAGTGAGCAGGAACTGAAAGCCATTGTCAAAGATCTTGGTTGT GGGCCATATTTTTTGGGCACCTATGACAAGCGCTTTCCAGGCTTTGTTTC TCCACACAAGCTCGCCTGCGCCATAGTCAATACGGCCGGTCGCGAGACTG GGGGCGTACACTGGATGGCCTTTGCCTGGAACCCGCACTCAAAAACATGC TACCTCTTTGAGCCCTTTGGCTTTTCTGACCAGCGACTCAAGCAGGTTTA CCAGTTTGAGTACGAGTCACTCCTGCGCCGTAGCGCCATTGCTTCTTCCC CCGACCGCTGTATAACGCTGGAAAAGTCCACCCAAAGCGTACAGGGGCCC AACTCGGCCGCCTGTGGACTATTCTGCTGCATGTTTCTCCACGCCTTTGC CAACTGGCCCCAAACTCCCATGGATCACAACCCCACCATGAACCTTATTA CCGGGGTACCCAACTCCATGCTCAACAGTCCCCAGGTACAGCCCACCCTG CGTCGCAACCAGGAACAGCTCTACAGCTTCCTGGAGCGCCACTCGCCCTA CTTCCGCAGCCACAGTGCGCAGATTAGGAGCGCCACTTCTTTTTGTCACT TGAAAAACATGTAAAAATAATGTACTAGAGACACTTTCAATAAAGGCAAA TGCTTTTATTTGTACACTCTCGGGTGATTATTTACCCCCACCCTTGCCGT CTGCGCCGTTTAAAAATCAAAGGGGTTCTGCCGCGCATCGCTATGCGCCA CTGGCAGGGACACGTTGCGATACTGGTGTTTAGTGCTCCACTTAAACTCA GGCACAACCATCCGCGGCAGCTCGGTGAAGTTTTCACTCCACAGGCTGCG CACCATCACCAACGCGTTTAGCAGGTCGGGCGCCGATATCTTGAAGTCGC AGTTGGGGCCTCCGCCCTGCGCGCGCGAGTTGCGATACACAGGGTTGCAG CACTGGAACACTATCAGCGCCGGGTGGTGCACGCTGGCCAGCACGCTCTT GTCGGAGATCAGATCCGCGTCCAGGTCCTCCGCGTTGCTCAGGGCGAACG GAGTCAACTTTGGTAGCTGCCTTCCCAAAAAGGGCGCGTGCCCAGGCTTT GAGTTGCACTCGCACCGTAGTGGCATCAAAAGGTGACCGTGCCCGGTCTG GGCGTTAGGATACAGCGCCTGCATAAAAGCCTTGATCTGCTTAAAAGCCA CCTGAGCCTTTGCGCCTTCAGAGAAGAACATGCCGCAAGACTTGCCGGAA AACTGATTGGCCGGACAGGCCGCGTCGTGCACGCAGCACCTTGCGTCGGT GTTGGAGATCTGCACCACATTTCGGCCCCACCGGTTCTTCACGATCTTGG CCTTGCTAGACTGCTCCTTCAGCGCGCGCTGCCCGTTTTCGCTCGTCACA TCCATTTCAATCACGTGCTCCTTATTTATCATAATGCTTCCGTGTAGACA CTTAAGCTCGCCTTCGATCTCAGCGCAGCGGTGCAGCCACAACGCGCAGC CCGTGGGCTCGTGATGCTTGTAGGTCACCTCTGCAAACGACTGCAGGTAC GCCTGCAGGAATCGCCCCATCATCGTCACAAAGGTCTTGTTGCTGGTGAA GGTCAGCTGCAACCCGCGGTGCTCCTCGTTCAGCCAGGTCTTGCATACGG CCGCCAGAGCTTCCACTTGGTCAGGCAGTAGTTTGAAGTTCGCCTTTAGA TCGTTATCCACGTGGTACTTGTCCATCAGCGCGCGCGCAGCCTCCATGCC CTTCTCCCACGCAGACACGATCGGCACACTCAGCGGGTTCATCACCGTAA TTTCACTTTCCGCTTCGCTGGGCTCTTCCTCTTCCTCTTGCGTCCGCATA CCACGCGCCACTGGGTCGTCTTCATTCAGCCGCCGCACTGTGCGCTTACC TCCTTTGCCATGCTTGATTAGCACCGGTGGGTTGCTGAAACCCACCATTT GTAGCGCCACATCTTCTCTTTCTTCCTCGCTGTCCACGATTACCTCTGGT GATGGCGGGCGCTCGGGCTTGGGAGAAGGGCGCTTCTTTTTCTTCTTGGG CGCAATGGCCAAATCCGCCGCCGAGGTCGATGGCCGCGGGCTGGGTGTGC GCGGCACCAGCGCGTCTTGTGATGAGTCTTCCTCGTCCTCGGACTCGATA CGCCGCCTCATCCGCTTTTTTGGGGGCGCCCGGGGAGGCGGCGGCGACGG GGACGGGGACGACACGTCCTCCATGGTTGGGGGACGTCGCGCCGCACCGC GTCCGCGCTCGGGGGTGGTTTCGCGCTGCTCCTCTTCCCGACTGGCCATT TCCTTCTCCTATAGGCAGAAAAAGATCATGGAGTCAGTCGAGAAGAAGGA CAGCCTAACCGCCCCCTCTGAGTTCGCCACCACCGCCTCCACCGATGCCG CCAACGCGCCTACCACCTTCCCCGTCGAGGCACCCCCGCTTGAGGAGGAG GAAGTGATTATCGAGCAGGACCCAGGTTTTGTAAGCGAAGACGACGAGGA CCGCTCAGTACCAACAGAGGATAAAAAGCAAGACCAGGACAACGCAGAGG CAAACGAGGAACAAGTCGGGCGGGGGGACGAAAGGCATGGCGACTACCTA GATGTGGGAGACGACGTGCTGTTGAAGCATCTGCAGCGCCAGTGCGCCAT TATCTGCGACGCGTTGCAAGAGCGCAGCGATGTGCCCCTCGCCATAGCGG ATGTCAGCCTTGCCTACGAACGCCACCTATTCTCACCGCGCGTACCCCCC AAACGCCAAGAAAACGGCACATGCGAGCCCAACCCGCGCCTCAACTTCTA CCCCGTATTTGCCGTGCCAGAGGTGCTTGCCACCTATCACATCTTTTTCC AAAACTGCAAGATACCCCTATCCTGCCGTGCCAACCGCAGCCGAGCGGAC AAGCAGCTGGCCTTGCGGCAGGGCGCTGTCATACCTGATATCGCCTCGCT CAACGAAGTGCCAAAAATCTTTGAGGGTCTTGGACGCGACGAGAAGCGCG CGGCAAACGCTCTGCAACAGGAAAACAGCGAAAATGAAAGTCACTCTGGA GTGTTGGTGGAACTCGAGGGTGACAACGCGCGCCTAGCCGTACTAAAACG CAGCATCGAGGTCACCCACTTTGCCTACCCGGCACTTAACCTACCCCCCA AGGTCATGAGCACAGTCATGAGTGAGCTGATCGTGCGCCGTGCGCAGCCC CTGGAGAGGGATGCAAATTTGCAAGAACAAACAGAGGAGGGCCTACCCGC AGTTGGCGACGAGCAGCTAGCGCGCTGGCTTCAAACGCGCGAGCCTGCCG ACTTGGAGGAGCGACGCAAACTAATGATGGCCGCAGTGCTCGTTACCGTG GAGCTTGAGTGCATGCAGCGGTTCTTTGCTGACCCGGAGATGCAGCGCAA GCTAGAGGAAACATTGCACTACACCTTTCGACAGGGCTACGTACGCCAGG CCTGCAAGATCTCCAACGTGGAGCTCTGCAACCTGGTCTCCTACCTTGGA ATTTTGCACGAAAACCGCCTTGGGCAAAACGTGCTTCATTCCACGCTCAA GGGCGAGGCGCGCCGCGACTACGTCCGCGACTGCGTTTACTTATTTCTAT GCTACACCTGGCAGACGGCCATGGGCGTTTGGCAGCAGTGCTTGGAGGAG TGCAACCTCAAGGAGCTGCAGAAACTGCTAAAGCAAAACTTGAAGGACCT ATGGACGGCCTTCAACGAGCGCTCCGTGGCCGCGCACCTGGCGGACATCA TTTTCCCCGAACGCCTGCTTAAAACCCTGCAACAGGGTCTGCCAGACTTC ACCAGTCAAAGCATGTTGCAGAACTTTAGGAACTTTATCCTAGAGCGCTC AGGAATCTTGCCCGCCACCTGCTGTGCACTTCCTAGCGACTTTGTGCCCA TTAAGTACCGCGAATGCCCTCCGCCGCTTTGGGGCCACTGCTACCTTCTG CAGCTAGCCAACTACCTTGCCTACCACTCTGACATAATGGAAGACGTGAG CGGTGACGGTCTACTGGAGTGTCACTGTCGCTGCAACCTATGCACCCCGC ACCGCTCCCTGGTTTGCAATTCGCAGCTGCTTAACGAAAGTCAAATTATC GGTACCTTTGAGCTGCAGGGTCCCTCGCCTGACGAAAAGTCCGCGGCTCC GGGGTTGAAACTCACTCCGGGGCTGTGGACGTCGGCTTACCTTCGCAAAT TTGTACCTGAGGACTACCACGCCCACGAGATTAGGTTCTACGAAGACCAA TCCCGCCCGCCTAATGCGGAGCTTACCGCCTGCGTCATTACCCAGGGCCA CATTCTTGGCCAATTGCAAGCCATCAACAAAGCCCGCCAAGAGTTTCTGC TACGAAAGGGACGGGGGGTTTACTTGGACCCCCAGTCCGGCGAGGAGCTC AACCCAATCCCCCCGCCGCCGCAGCCCTATCAGCAGCAGCCGCGGGCCCT TGCTTCCCAGGATGGCACCCAAAAAGAAGCTGCAGCTGCCGCCGCCACCC ACGGACGAGGAGGAATACTGGGACAGTCAGGCAGAGGAGGTTTTGGACGA GGAGGAGGAGGACATGATGGAAGACTGGGAGAGCCTAGACGAGGAAGCTT CCGAGGTCGAAGAGGTGTCAGACGAAACACCGTCACCCTCGGTCGCATTC CCCTCGCCGGCGCCCCAGAAATCGGCAACCGGTTCCAGCATGGCTACAAC CTCCGCTCCTCAGGCGCCGCCGGCACTGCCCGTTCGCCGACCCAACCGTA GATGGGACACCACTGGAACCAGGGCCGGTAAGTCCAAGCAGCCGCCGCCG TTAGCCCAAGAGCAACAACAGCGCCAAGGCTACCGCTCATGGCGCGGGCA CAAGAACGCCATAGTTGCTTGCTTGCAAGACTGTGGGGGCAACATCTCCT TCGCCCGCCGCTTTCTTCTCTACCATCACGGCGTGGCCTTCCCCCGTAAC ATCCTGCATTACTACCGTCATCTCTACAGCCCATACTGCACCGGCGGCAG CGGCAGCAACAGCAGCGGCCACACAGAAGCAAAGGCGACCGGATAGCAAG ACTCTGACAAAGCCCAAGAAATCCACAGCGGCGGCAGCAGCAGGAGGAGG AGCGCTGCGTCTGGCGCCCAACGAACCCGTATCGACCCGCGAGCTTAGAA ACAGGATTTTTCCCACTCTGTATGCTATATTTCAACAGAGCAGGGGCCAA GAACAAGAGCTGAAAATAAAAAACAGGTCTCTGCGATCCCTCACCCGCAG CTGCCTGTATCACAAAAGCGAAGATCAGCTTCGGCGCACGCTGGAAGACG CGGAGGCTCTCTTCAGTAAATACTGCGCGCTGACTCTTAAGGACTAGTTT CGCGCCCTTTCTCAAATTTAAGCGCGAAAACTACGTCATCTCCAGCGGCC ACACCCGGCGCCAGCACCTGTTGTCAGCGCCATTATGAGCAAGGAAATTC CCACGCCCTACATGTGGAGTTACCAGCCACAAATGGGACTTGCGGCTGGA GCTGCCCAAGACTACTCAACCCGAATAAACTACATGAGCGCGGGACCCCA CATGATATCCCGGGTCAACGGAATACGCGCCCACCGAAACCGAATTCTCC TGGAACAGGCGGCTATTACCACCACACCTCGTAATAACCTTAATCCCCGT AGTTGGCCCGCTGCCCTGGTGTACCAGGAAAGTCCCGCTCCCACCACTGT GGTACTTCCCAGAGACGCCCAGGCCGAAGTTCAGATGACTAACTCAGGGG CGCAGCTTGCGGGCGGCTTTCGTCACAGGGTGCGGTCGCCCGGGCAGGGT ATAACTCACCTGACAATCAGAGGGCGAGGTATTCAGCTCAACGACGAGTC GGTGAGCTCCTCGCTTGGTCTCCGTCCGGACGGGACATTTCAGATCGGCG GCGCCGGCCGCTCTTCATTCACGCCTCGTCAGGCAATCCTAACTCTGCAG ACCTCGTCCTCTGAGCCGCGCTCTGGAGGCATTGGAACTCTGCAATTTAT TGAGGAGTTTGTGCCATCGGTCTACTTTAACCCCTTCTCGGGACCTCCCG GCCACTATCCGGATCAATTTATTCCTAACTTTGACGCGGTAAAGGACTCG GCGGACGGCTACGACTGAATGTTAAGTGGAGAGGCAGAGCAACTGCGCCT GAAACACCTGGTCCACTGTCGCCGCCACAAGTGCTTTGCCCGCGACTCCG GTGAGTTTTGCTACTTTGAATTGCCCGAGGATCATATCGAGGGCCCGGCG CACGGCGTCCGGCTTACCGCCCAGGGAGAGCTTGCCCGTAGCCTGATTCG GGAGTTTACCCAGCGCCCCCTGCTAGTTGAGCGGGACAGGGGACCCTGTG TTCTCACTGTGATTTGCAACTGTCCTAACCCTGGATTACATCAAGATCCT CTAGTTAATGTCAGGTCGCCTAAGTCGATTAACTAGAGTACCCGGGGATC TTATTCCCTTTAACTAATAAAAAAAAATAATAAAGCATCACTTACTTAAA ATCAGTTAGCAAATTTCTGTCCAGTTTATTCAGCAGCACCTCCTTGCCCT CCTCCCAGCTCTGGTATTGCAGCTTCCTCCTGGCTGCAAACTTTCTCCAC AATCTAAATGGAATGTCAGTTTCCTCCTGTTCCTGTCCATCCGCACCCAC TATCTTCATGTTGTTGCAGATGAAGCGCGCAAGACCGTCTGAAGATACCT TCAACCCCGTGTATCCATATGACACGGAAACCGGTCCTCCAACTGTGCCT TTTCTTACTCCTCCCTTTGTATCCCCCAATGGGTTTCAAGAGAGTCCCCC TGGGGTACTCTCTTTGCGCCTATCCGAACCTCTAGTTACCTCCAATGGCA TGCTTGCGCTCAAAATGGGCAACGGCCTCTCTCTGGACGAGGCCGGCAAC CTTACCTCCCAAAATGTAACCACTGTGAGCCCACCTCTCAAAAAAACCAA GTCAAACATAAACCTGGAAATATCTGCACCCCTCACAGTTACCTCAGAAG CCCTAACTGTGGCTGCCGCCGCACCTCTAATGGTCGCGGGCAACACACTC ACCATGCAATCACAGGCCCCGCTAACCGTGCACGACTCCAAACTTAGCAT TGCCACCCAAGGACCCCTCACAGTGTCAGAAGGAAAGCTAGCCCTGCAAA CATCAGGCCCCCTCACCACCACCGATAGCAGTACCCTTACTATCACTGCC TCACCCCCTCTAACTACTGCCACTGGTAGCTTGGGCATTGACTTGAAAGA GCCCATTTATACACAAAATGGAAAACTAGGACTAAAGTACGGGGCTCCTT TGCATGTAACAGACGACCTAAACACTTTGACCGTAGCAACTGGTCCAGGT GTGACTATTAATAATACTTCCTTGCAAACTAAAGTTACTGGAGCCTTGGG TTTTGATTCACAAGGCAATATGCAACTTAATGTAGCAGGAGGACTAAGGA TTGATTCTCAAAACAGACGCCTTATACTTGATGTTAGTTATCCGTTTGAT GCTCAAAACCAACTAAATCTAAGACTAGGACAGGGCCCTCTTTTTATAAA CTCAGCCCACAACTTGGATATTAACTACAACAAAGGCCTTTACTTGTTTA CAGCTTCAAACAATTCCAAAAAGCTTGAGGTTAACCTAAGCACTGCCAAG GGGTTGATGTTTGACGCTACAGCCATAGCCATTAATGCAGGAGATGGGCT TGAATTTGGTTCACCTAATGCACCAAACACAAATCCCCTCAAAACAAAAA TTGGCCATGGCCTAGAATTTGATTCAAACAAGGCTATGGTTCCTAAACTA GGAACTGGCCTTAGTTTTGACAGCACAGGTGCCATTACAGTAGGAAACAA AAATAATGATAAGCTAACTTTGTGGACCACACCAGCTCCATCTCCTAACT GTAGACTAAATGCAGAGAAAGATGCTAAACTCACTTTGGTCTTAACAAAA TGTGGCAGTCAAATACTTGCTACAGTTTCAGTTTTGGCTGTTAAAGGCAG TTTGGCTCCAATATCTGGAACAGTTCAAAGTGCTCATCTTATTATAAGAT TTGACGAAAATGGAGTGCTACTAAACAATTCCTTCCTGGACCCAGAATAT TGGAACTTTAGAAATGGAGATCTTACTGAAGGCACAGCCTATACAAACGC TGTTGGATTTATGCCTAACCTATCAGCTTATCCAAAATCTCACGGTAAAA CTGCCAAAAGTAACATTGTCAGTCAAGTTTACTTAAACGGAGACAAAACT AAACCTGTAACACTAACCATTACACTAAACGGTACACAGGAAACAGGAGA CACAACTCCAAGTGCATACTCTATGTCATTTTCATGGGACTGGTCTGGCC ACAACTACATTAATGAAATATTTGCCACATCCTCTTACACTTTTTCATAC ATTGCCCAAGAATAAAGAATCGTTTGTGTTATGTTTCAACGTGTTTATTT TTCAATTGCAGAAAATTTCAAGTCATTTTTCATTCAGTAGTATAGCCCCA CCACCACATAGCTTATACAGATCACCGTACCTTAATCAAACTCACAGAAC CCTAGTATTCAACCTGCCACCTCCCTCCCAACACACAGAGTACACAGTCC TTTCTCCCCGGCTGGCCTTAAAAAGCATCATATCATGGGTAACAGACATA TTCTTAGGTGTTATATTCCACACGGTTTCCTGTCGAGCCAAACGCTCATC AGTGATATTAATAAACTCCCCGGGCAGCTCACTTAAGTTCATGTCGCTGT CCAGCTGCTGAGCCACAGGCTGCTGTCCAACTTGCGGTTGCTTAACGGGC GGCGAAGGAGAAGTCCACGCCTACATGGGGGTAGAGTCATAATCGTGCAT CAGGATAGGGCGGTGGTGCTGCAGCAGCGCGCGAATAAACTGCTGCCGCC GCCGCTCCGTCCTGCAGGAATACAACATGGCAGTGGTCTCCTCAGCGATG ATTCGCACCGCCCGCAGCATAAGGCGCCTTGTCCTCCGGGCACAGCAGCG CACCCTGATCTCACTTAAATCAGCACAGTAACTGCAGCACAGCACCACAA TATTGTTCAAAATCCCACAGTGCAAGGCGCTGTATCCAAAGCTCATGGCG GGGACCACAGAACCCACGTGGCCATCATACCACAAGCGCAGGTAGATTAA GTGGCGACCCCTCATAAACACGCTGGACATAAACATTACCTCTTTTGGCA TGTTGTAATTCACCACCTCCCGGTACCATATAAACCTCTGATTAAACATG GCGCCATCCACCACCATCCTAAACCAGCTGGCCAAAACCTGCCCGCCGGC TATACACTGCAGGGAACCGGGACTGGAACAATGACAGTGGAGAGCCCAGG ACTCGTAACCATGGATCATCATGCTCGTCATGATATCAATGTTGGCACAA CACAGGCACACGTGCATACACTTCCTCAGGATTACAAGCTCCTCCCGCGT TAGAACCATATCCCAGGGAACAACCCATTCCTGAATCAGCGTAAATCCCA CACTGCAGGGAAGACCTCGCACGTAACTCACGTTGTGCATTGTCAAAGTG TTACATTCGGGCAGCAGCGGATGATCCTCCAGTATGGTAGCGCGGGTTTC TGTCTCAAAAGGAGGTAGACGATCCCTACTGTACGGAGTGCGCCGAGACA ACCGAGATCGTGTTGGTCGTAGTGTCATGCCAAATGGAACGCCGGACGTA GTCATATTTCCTGAAGCAAAACCAGGTGCGGGCGTGACAAACAGATCTGC GTCTCCGGTCTCGCCGCTTAGATCGCTCTGTGTAGTAGTTGTAGTATATC CACTCTCTCAAAGCATCCAGGCGCCCCCTGGCTTCGGGTTCTATGTAAAC TCCTTCATGCGCCGCTGCCCTGATAACATCCACCACCGCAGAATAAGCCA CACCCAGCCAACCTACACATTCGTTCTGCGAGTCACACACGGGAGGAGCG GGAAGAGCTGGAAGAACCATGTTTTTTTTTTTATTCCAAAAGATTATCCA AAACCTCAAAATGAAGATCTATTAAGTGAACGCGCTCCCCTCCGGTGGCG TGGTCAAACTCTACAGCCAAAGAACAGATAATGGCATTTGTAAGATGTTG CACAATGGCTTCCAAAAGGCAAACGGCCCTCACGTCCAAGTGGACGTAAA GGCTAAACCCTTCAGGGTGAATCTCCTCTATAAACATTCCAGCACCTTCA ACCATGCCCAAATAATTCTCATCTCGCCACCTTCTCAATATATCTCTAAG CAAATCCCGAATATTAAGTCCGGCCATTGTAAAAATCTGCTCCAGAGCGC CCTCCACCTTCAGCCTCAAGCAGCGAATCATGATTGCAAAAATTCAGGTT CCTCACAGACCTGTATAAGATTCAAAAGCGGAACATTAACAAAAATACCG CGATCCCGTAGGTCCCTTCGCAGGGCCAGCTGAACATAATCGTGCAGGTC TGCACGGACCAGCGCGGCCACTTCCCCGCCAGGAACCATGACAAAAGAAC CCACACTGATTATGACACGCATACTCGGAGCTATGCTAACCAGCGTAGCC CCGATGTAAGCTTGTTGCATGGGCGGCGATATAAAATGCAAGGTGCTGCT CAAAAAATCAGGCAAAGCCTCGCGCAAAAAAGAAAGCACATCGTAGTCAT GCTCATGCAGATAAAGGCAGGTAAGCTCCGGAACCACCACAGAAAAAGAC ACCATTTTTCTCTCAAACATGTCTGCGGGTTTCTGCATAAACACAAAATA AAATAACAAAAAAACATTTAAACATTAGAAGCCTGTCTTACAACAGGAAA AACAACCCTTATAAGCATAAGACGGACTACGGCCATGCCGGCGTGACCGT AAAAAAACTGGTCACCGTGATTAAAAAGCACCACCGACAGCTCCTCGGTC ATGTCCGGAGTCATAATGTAAGACTCGGTAAACACATCAGGTTGATTCAC ATCGGTCAGTGCTAAAAAGCGACCGAAATAGCCCGGGGGAATACATACCC GCAGGCGTAGAGACAACATTACAGCCCCCATAGGAGGTATAACAAAATTA ATAGGAGAGAAAAACACATAAACACCTGAAAAACCCTCCTGCCTAGGCAA AATAGCACCCTCCCGCTCCAGAACAACATACAGCGCTTCCACAGCGGCAG CCATAACAGTCAGCCTTACCAGTAAAAAAGAAAACCTATTAAAAAAACAC CACTCGACACGGCACCAGCTCAATCAGTCACAGTGTAAAAAAGGGCCAAG TGCAGAGCGAGTATATATAGGACTAAAAAATGACGTAACGGTTAAAGTCC ACAAAAAACACCCAGAAAACCGCACGCGAACCTACGCCCAGAAACGAAAG CCAAAAAACCCACAACTTCCTCAAATCGTCACTTCCGTTTTCCCACGTTA CGTCACTTCCCATTTTAAGAAAACTACAATTCCCAACACATACAAGTTAC TCCGCCCTAAAACCTACGTCACCCGCCCCGTTCCCACGCCCCGCGCCACG TCACAAACTCCACCCCCTCATTATCATATTGGCTTCAATCCAAAATAAGG TATATTATTGATGAT,.

In some embodiments, an adenovirus-derived vector, optionally relating to a replication defective adenovirus, comprises a sequence with at least 75%, 80%, 85%, 90%, 95%, 98%, 99%, 99.5%, 99.8%, 99.9% identity to SEQ. ID. NO: 3 or a sequence generated from SEQ. ID. NO: 3 by alternative codon replacements. In various embodiments, the adenovirus-derived vectors described herein have a deletion in the E2b region, and optionally, in the E1 region, the deletion conferring a variety of advantages to the use of the vectors in immunotherapy as described herein.

Certain regions within the adenovirus genome serve essential functions and may need to be substantially conserved when constructing the replication defective adenovirus vectors of the invention. These regions are further described in Lauer (Lauer et al. Natural variation among human adenoviruses: genome sequence and annotation of human adenovirus serotype 1. Journal of General Virology (2004), 85, 2615-2625), Leza (Leza et al. Cellular Transcription Factor Binds to Adenovirus Early Region Promotersandtoa CyclicAMP ResponseElement. Journal OF VIROLOGY, August 1988, p. 3003-3013), and Miralles (Miralles et al. The Adenovirus Inverted Terminal Repeat Functions as an Enhancer in a Cell-free System. THE JOURNAL OF BIOLOGICAL CHEMISTRY. Vol. 264, No. 18, Issue of June 25, pp. 10763-10772, 1983), which are each herein incorporate by reference in their entirety. Recombinant nucleic acid vectors comprising a sequence with identity values of at least 75%, 80%, 85%, 90%, 95%, 98%, 99%, 99.5%, 99.8%, 99.9% to a portion of SEQ. ID. NO: 3 are within the bounds of the invention.

First generation, E1-deleted Adenovirus subtype 5 (Ad5)-based vectors, although promising platforms for use as cancer vaccines, are impeded in activity by naturally occurring or induced Ad-specific neutralizing antibodies. Ad5-based vectors with deletions of the E1 and the E2b regions (Ad5 [E1-, E2b-]), the latter encoding the DNA polymerase and the pre-terminal protein, by virtue of diminished late phase viral protein expression, provide an opportunity to avoid immunological clearance and induce more potent immune responses against the encoded tumor antigen transgene in Ad-immune hosts. Indeed, multiple homologous immunizations with Ad5 [E1-, E2b-]-CEA(6D), encoding a variant of the tumor antigen CEA, induced CEA-specific cell-mediated immune (CMI) responses with antitumor activity in mice despite the presence of pre-existing or induced Ad5-neutralizing antibody. In a phase I/II study, cohorts of patients with advanced colorectal cancer were immunized with escalating doses of Ad5 [E1-, E2b-]-CEA(6D). CEA-specific CMI responses were observed despite the presence of pre-existing Ad5 immunity in a majority (61.3%) of patients. Importantly, there was minimal toxicity, and overall patient survival (48% at 12 months) was similar regardless of pre-existing Ad5 neutralizing antibody titers. The results demonstrated that, in cancer patients, the novel Ad5 [E1-, E2b-] gene delivery platform generates significant CMI responses to the tumor antigen CEA in the setting of both naturally acquired and immunization-induced Ad5 specific immunity. CEA antigen specific CMI can be, for example, greater than 10, 20, 30, 40, 50, 100, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 5000, 10000, or more IFN-γ spot forming cells (SFC) per 10⁶ peripheral blood mononuclear cells (PBMC). Thus, the methods and compositions of the invention relate to a recombinant nucleic acid vector, wherein the recombinant nucleic acid vector comprises a replication defective adenovirus vector, and wherein upon administration to a human, the composition is capable of inducing an immune response directed towards cells expressing CEA antigen in said human. The immune response may be induced even in the presence of preexisting immunity against Ad5. In some embodiments, the immune response is raised in a human subject with a preexisting inverse Ad5 neutralizing antibody titer of greater than 50, 100, 150, 200, 300, 400, 500, 600, 700, 800, 900, 1000, 1500, 2000, 2500, 3000, 3500, 4000, 4500, 5000, 6000, 7000, 8000, 9000, 1000, 12000, 15000 or higher. The immune response may comprise a cell-mediated immunity and/or a humoral immunity as described herein. The immune response may be measured by one or more of intracellular cytokine staining (ICS), ELISpot, proliferation assays, cytotoxic T cell assays including chromium release or equivalent assays, and gene expression analysis using any number of polymerase chain reaction (PCR) or RT-PCR based assays, as described herein and to the extent they are available to a person skilled in the art, as well as any other suitable assays known in the art for measuring immune response.

While cancer immunotherapy achieved by delivering tumor-associated antigens (TAA) provides survival benefits, limitations to these strategies exist and more immunologically potent vaccines are needed. To address the low immunogenicity of self-tumor antigens, a variety of advanced, multi-component vaccination strategies including co-administration of adjuvants and immune stimulating cytokines are provided. The invention relates to recombinant viral vectors that inherently provide innate pro-inflammatory signals, while simultaneously engineered to express the antigen of interest. Of particular interest are adenovirus serotype-5 (Ad5)-based immunotherapeutics that have been repeatedly used in humans to induce robust T cell-mediated immune (CMI) responses, all while maintaining an extensive safety profile. In addition, Ad5 vectors can be reliably manufactured in large quantities and are stable for storage and delivery for outpatient administration. Nonetheless, a major obstacle to the use of first generation (E1-deleted) Ad5-based vectors is the high frequency of pre-existing anti-adenovirus type 5 neutralizing antibodies. These antibodies can be present in a potential vaccinee due to either prior wild type adenovirus infection and/or induction of adenovirus neutralizing antibodies by repeated injections with Ad5-based vaccines, each resulting in inadequate immune stimulation against the target TAA.

Attempts to overcome anti-Ad immunity have included use of alternative Ad serotypes and/or alternations in the Ad5 viral capsid protein each with limited success and the potential for significantly altering biodistribution of the resultant vaccines. Therefore, a completely novel approach was attempted by further reducing the expression of viral proteins from the E1 deleted Ad5 vectors, proteins known to be targets of pre-existing Ad immunity. Specifically, a novel recombinant Ad5 platform has been described with deletions in the early 1 (E1) gene region and additional deletions in the early 2b (E2b) gene region (Ad5 [E1-, E2b-]). Deletion of the E2b region (that encodes DNA polymerase and the pre-terminal protein) results in decreased viral DNA replication and late phase viral protein expression. This vector platform has been previously reported to successfully induce CMI responses in animal models of cancer and infectious disease and more importantly, this recombinant Ad5 gene delivery platform overcomes the barrier of Ad5 immunity and can be used in the setting of pre-existing and/or vector-induced Ad immunity thus enabling multiple homologous administrations of the vaccine. We have constructed and tested an Ad5 [E1-, E2b-] platform containing a gene insert for the tumor antigen carcinoembryonic antigen (CEA) with a modification that enhances T cell responses (Ad5 [E1-, E2b-]-CEA(6D) and is used in various embodiments of the invention for therapies raising an immune response against CEA. Multiple immunizations with this Ad5 platform induced CEA-specific CMI responses with antitumor activity despite the presence of existing Ad5 immunity in mice. The results of a first-in-man, phase I/II clinical trial demonstrate safety and immunogenicity in humans. A dose escalation of the Ad5 [E1-, E2b-]-CEA(6D) vector in advanced stage colorectal cancer patients demonstrates that CMI can be induced without a substantial effect on clinical outcome relative to the existence of pre-existing Ad5-immunity.

CEA as Target for Immune Response

CEA represents an attractive target antigen for immunotherapy since it is over-expressed in nearly all colorectal cancers and pancreatic cancers, and is also expressed by some lung and breast cancers, and uncommon tumors such as medullary thyroid cancer, but is not expressed in other cells of the body except for low-level expression in gastrointestinal epithelium (Berinstein, N. L. 2002. Carcinoembryonic antigen as a target for therapeutic anticancer vaccines: a review. J Clin Oncol 20:2197-2207.). CEA contains epitopes that may be recognized in an MHC restricted fashion by T cells.

Members of the CEA gene family are subdivided into three subgroups based on sequence similarity, developmental expression patterns and their biological functions: the CEA-related Cell Adhesion Molecule (CEACAM) subgroup containing twelve genes (CEACAM1, CEACAM3-CEACAM8, CEACAM16 and CEACAM18-CEACAM21), the Pregnancy Specific Glycoprotein (PSG) subgroup containing eleven closely related genes (PSG1-PSG11) and a subgroup of eleven pseudogenes (CEACAMP1-CEACAMP11) (Zhou et al. 2000; Gray-Owen and Blumberg 2006; FIGS. 1.4-1.5). Most members of the CEACAM subgroup have similar structures consist of an extracellular Ig-like domains composed of a single N-terminal V-set domain, with structural homology to the immunoglobulin variable domains, followed by varying numbers of C2-set domains of A or B subtypes, a transmembrane domain and a cytoplasmic domain (Beauchemin et al. 1999; Kammerer et al., 2007). There are two members of CEACAM subgroup (CEACAM16 and CEACAM20) that show a few exceptions in the organization of their structures. CEACAM16 contains two Ig-like V-type domains at its N and C termini and CEACAM20 contains a truncated Ig-like V-type 1 domain (FIG. 1.4). The CEACAM molecules can be anchored to the cell surface via their transmembrane domains (CEACAM5 thought CEACAM8) or directly linked to glycophosphatidylinositol (GPI) lipid moiety (CEACAM5, CEACAM18 thought CEACAM21).

Members of CEA family are known to be expressed in different cell types and have a wide range of biological functions. CEACAMs are found prominently on most epithelial cells and are present on different leucocytes. In humans, CEACAM1, the ancestor member of CEA family, is expressed on the apical side of epithelial and endothelial cells as well as on lymphoid and myeloid cells. CEACAM1 mediates cell-cell adhesion through homophilic (CEACAM1 to CEACAM1) as well as heterophilic (e.g. CEACAM1 to CEACAM5) interactions (Kuespert et al. 2006; Gray-Owen and Blumberg 2006). In addition, CEACAM1 is involved in many other biological processes, such as angiogenesis, cell migration, and immune functions (Gray-Owen and Blumberg 2006). CEACAM3 and CEACAM4 expression is largely restricted to granulocytes, and they are able to convey uptake and destruction of several bacterial pathogens including Neisseria, Moraxella, and Haemophilus species (Schmitter et al. 2004).

Thus, in various embodiments, compositions and methods of the invention relate to raising an immune response against a CEA, selected from the group consisting of CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21, PSG1, PSG2, PSG3, PSG4, PSG5, PSG6, PSG7, PSG8, PSG9, and PSG11. An immune response may be raised against cells, e.g. cancer cells, expressing or overexpressing one or more of the CEAs, using the methods and compositions of the invention. In some embodiments, the overexpression of the one or more CEAs in such cancer cells is over 5, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100 fold or more compared to non-cancer cells.

Further, compositions and methods of the invention, in various embodiments, take advantage of human cytolytic T cells (CTLs), specifically those that recognize CEA epitopes which bind to selected MHC molecules, e.g. HLA-A2, A3, and A24. Individuals expressing MHC molecules of certain serotypes, e.g. HLA-A2, A3, and A24 may be selected for therapy using the methods and compositions of the invention. For example, individuals expressing MHC molecules of certain serotypes, e.g. HLA-A2, A3, and A24, may be selected for a therapy including raising an immune response against CEA, using the methods and compositions described herein.

In various embodiments, these T cells can be generated by in vitro cultures using antigen-presenting cells pulsed with the epitope of interest to stimulate peripheral blood mononuclear cells. In addition, T cell lines can also be generated after stimulation with CEA latex beads, CEA protein-pulsed plastic adherent peripheral blood mononuclear cells, or DCs sensitized with CEA RNA. T cells can also be generated from patients immunized with a vaccine vector encoding CEA immunogen. HLA A2-presented peptides from CEA can further be found in primary gastrointestinal tumors. In various embodiments, the invention relates to an HLA A2 restricted epitope of CEA, CAP-1, a nine amino acid sequence (YLSGANLNL; SEQ. ID. NO.: 4), with ability to stimulate CTLs from cancer patients immunized with vaccine-CEA. Cap-1(6D) (YLSGADLNL; SEQ. ID. NO.: 5) is a peptide analog of CAP-1. Its sequence includes a heteroclitic (nonanchor position) mutation, resulting in an amino acid change from Asn to Asp, enhancing recognition by the T-cell receptor. The Asn to Asp mutation appears to not cause any change in the binding of the peptide to HLA A2. Compared with the non-mutated CAP-1 epitope, Cap-1(6D) can enhance the sensitization of CTLs by 100 to 1,000 times (Tsang, K. Y., Zhu, M., Nieroda, C. A., Correale, P., Zaremba, S., Hamilton, J. M., Cole, D., Lam, C., and Schlom, J. 1997. Phenotypic stability of a cytotoxic T-cell line directed against an immunodominant epitope of human carcinoembryonic antigen. Clin Cancer Res 3:2439-2449; Zaremba, S., Barzaga, E., Zhu, M., Soares, N., Tsang, K. Y., and Schlom, J. 1997. Identification of an enhancer agonist cytotoxic T lymphocyte peptide from human carcinoembryonic antigen. Cancer Res 57:4570-4577; Tangri, S., Ishioka, G. Y., Huang, X., Sidney, J., Southwood, S., Fikes, J., and Sette, A. 2001. Structural features of peptide analogs of human histocompatibility leukocyte antigen class I epitopes that are more potent and immunogenic than wild-type peptide. J Exp Med 194:833-846). CTL lines can be elicited from peripheral blood mononuclear cells of healthy volunteers by in vitro sensitization to the Cap-1(6D) peptide, but not significantly to the CAP-1 peptide. These cell lines can lyse human tumor cells expressing endogenous CEA. Thus, polypeptide sequences comprising CAP-1 or CAP-1(6D), nucleic acid sequences encoding such sequences, an adenovirus vectors; for example replication defective adenovirus vectors, comprising such nucleic acid sequences are within the bounds of the invention.

Clinical Trials of Vaccines Targeting CEA

Although CEA can serve as a T cell target and CEA-specific T cell precursors exist in humans, their frequency is quite low (<1/100,000). The invention, in various embodiments relates to increasing their numbers sufficiently and harnessing them to lyse CEA-expressing tumor cells. Several phase I clinical trials assessing various vaccine approaches for activating CEA-specific T cells were performed. Early studies were based on vaccination using protein with adjuvant (Samanci, A., Yi, Q., Fagerberg, J., Strigård, K., Smith, G., Rudén, U., Wahren, B., and Mellstedt, H. 1998. Pharmacological administration of granulocyte/macrophage-colony-stimulating factor is of significant importance for the induction of a strong humoral and cellular response in patients immunized with recombinant carcinoembryonic antigen. Cancer Immunol Immunother 47:131-142), or in the form of anti-idiotype vaccines (Foon, K. A., John, W. J., Chakraborty, M., Das, R., Teitelbaum, A., Garrison, J., Kashala, O., Chatterjee, S. K., and Bhattacharya-Chatterjee, M. 1999. Clinical and immune responses in resected colon cancer patients treated with anti-idiotype monoclonal antibody vaccine that mimics the carcinoembryonic antigen. J Clin Oncol 17:2889-2885; Foon, K. A., John, W. J., Chakraborty, M., Sherratt, A., Garrison, J., Flett, M., and Bhattacharya-Chatterjee, M. 1997. Clinical and immune responses in advanced colorectal cancer patients treated with anti-idiotype monoclonal antibody vaccine that mimics the carcinoembryonic antigen. Clin Cancer Res 3:1267-1276). CEA-specific T cell proliferative responses were observed in a substantial proportion of the patients in these studies; although the magnitude of the immune responses was modest. In order to improve upon these results, poxviruses engineered to express tumor antigens have been developed (Paoletti, E. 1996. Applications of pox virus vectors to vaccination: an update. Proc Natl Acad Sci USA 93:11349-11353; Cox, W. I., Tartaglia, J., and Paoletti, E. 1993. Induction of cytotoxic T lymphocytes by recombinant canarypox (ALVAC) and attenuated vaccinia (NYVAC) viruses expressing the HIV-1 envelope glycoprotein. Virology 195:845-850; Taylor, J., Trimarchi, C., Weinberg, R., Languet, B., Guillemin, F., Desmettre, P., and Paoletti, E. 1991. Efficacy studies on a canarypox-rabies recombinant virus. Vaccine 9:190-193). Both the vaccinia poxvirus and ALVAC, a variant of the canary poxvirus, have been genetically engineered to contain the genes that encode for various antigens, so that when the virus is injected into the body, it enters the host's cells and induces them to produce the antigen of interest. Because these vectors do not integrate into the genome, there is no risk of insertional mutagenesis, and expression of viral products and transgenes is transient, lasting only 10 to 14 days. Various immunization schemes against CEA utilizing such vectors were previously studied, but showed limited to no clinical response.

The compositions and methods of the invention, in various embodiments, provide adenovirus based vectors expressing a variant CEA for immunization against CEA. These vectors can raise an immune response against CEA. Further, in various embodiments, the composition and methods of the invention lead to clinical responses, such as altered disease progression or life expectancy.

Ad5 Vaccines

Adenoviruses are a family of DNA viruses characterized by an icosohedral, non-enveloped capsid containing a linear double-stranded genome. Of the human Ads, none are associated with any neoplastic disease, and only cause relatively mild, self-limiting illness in immunocompetent individuals. The first genes expressed by the virus are the E1 genes, which act to initiate high-level gene expression from the other Ad5 gene promoters present in the wild type genome. Viral DNA replication and assembly of progeny virions occur within the nucleus of infected cells, and the entire life cycle takes about 36 hr with an output of approximately 10⁴ virions per cell. The wild type Ad5 genome is approximately 36 kb, and encodes genes that are divided into early and late viral functions, depending on whether they are expressed before or after DNA replication. The early/late delineation is nearly absolute, since it has been demonstrated that super-infection of cells previously infected with an Ad5 results in lack of late gene expression from the super-infecting virus until after it has replicated its own genome. Without bound by theory, this is likely due to a replication dependent cis-activation of the Ad5 major late promoter (MLP), preventing late gene expression (primarily the Ad5 capsid proteins) until replicated genomes are present to be encapsulated. The composition and methods of the invention take advantage of feature in the development of advanced generation Ad vectors/vaccines.

Ad5 Vectors

First generation, or E1-deleted adenovirus vectors Ad5 [E1-] are constructed such that a transgene replaces only the E1 region of genes. Typically, about 90% of the wild-type Ad5 genome is retained in the vector. Ad5 [E1-] vectors have a decreased ability to replicate and cannot produce infectious virus after infection of cells not expressing the Ad5 E1 genes. The recombinant Ad5 [E1-] vectors are propagated in human cells (typically 293 cells) allowing for Ad5 [E1-] vector replication and packaging. Ad5 [E1-] vectors have a number of positive attributes; one of the most important is their relative ease for scale up and cGMP production. Currently, well over 220 human clinical trials utilize Ad5 [E1-] vectors, with more than two thousand subjects given the virus sc, im, or iv. Additionally, Ad5 vectors do not integrate; their genomes remain episomal. Generally, for vectors that do not integrate into the host genome, the risk for insertional mutagenesis and/or germ-line transmission is extremely low if at all. Conventional Ad5 [E1-] vectors have a carrying capacity that approaches 7 kb.

Ad5 [E1-] Vectors Used as a Cancer Vaccine:

Arthur et. al. demonstrated that Ad5 [E1-] vectors encoding a variety of antigens could efficiently transduce 95% of ex vivo exposed DC's to high titers of the vector (Arthur, J. F., Butterfield, L. H., Roth, M. D., Bui, L. A., Kiertscher, S. M., Lau, R., Dubinett, S., Glaspy, J., McBride, W. H., and Economou, J. S. 1997. A comparison of gene transfer methods in human dendritic cells. Cancer Gene Ther 4:17-25). Importantly, increasing levels of foreign gene expression were noted in the DC with increasing multiplicities of infection (MOI) with the vector, a finding repeated by others, as well as reproduced in our preliminary studies (Diao, J., Smythe, J. A., Smyth, C., Rowe, P. B., and Alexander, I. E. 1999. Human PBMC-derived dendritic cells transduced with an adenovirus vector induce cytotoxic T-lymphocyte responses against a vector-encoded antigen in vitro. Gene Ther 6:845-853). It has been demonstrated that DC infected with Ad5 [E1-] vectors encoding a variety of antigens (including the tumor antigens MART-1, MAGE-A4, DF3/MUC1, p53, hugp100 melanoma antigen, polyoma virus middle-T antigen) have the propensity to induce antigen specific CTL responses, have an enhanced antigen presentation capacity, and have an improved ability to initiate T-cell proliferation in mixed lymphocyte reactions (Arthur, J. F., Butterfield, L. H., Roth, M. D., Bui, L. A., Kiertscher, S. M., Lau, R., Dubinett, S., Glaspy, J., McBride, W. H., and Economou, J. S. 1997. A comparison of gene transfer methods in human dendritic cells. Cancer Gene Ther 4:17-25; Diao, J., Smythe, J. A., Smyth, C., Rowe, P. B., and Alexander, I. E. 1999. Human PBMC-derived dendritic cells transduced with an adenovirus vector induce cytotoxic T-lymphocyte responses against a vector-encoded antigen in vitro. Gene Ther 6:845-853; Brossart, P., Goldrath, A. W., Butz, E. A., Martin, S., and Bevan, M. J. 1997. Virus-mediated delivery of antigenic epitopes into dendritic cells as a means to induce CTL. J Immunol 158:3270-3276; Butterfield, L. H., Jilani, S. M., Chakraborty, N. G., Bui, L. A., Ribas, A., Dissette, V. B., Lau, R., Gamradt, S. C., Glaspy, J. A., McBride, W. H., et al. 1998. Generation of melanoma-specific cytotoxic T lymphocytes by dendritic cells transduced with a MART-1 adenovirus. J Immunol 161:5607-5613; Bregni, M., Shammah, S., Malaffo, F., Di Nicola, M., Milanesi, M., Magni, M., Matteucci, P., Ravagnani, F., Jordan, C. T., Siena, S., et al. 1998. Adenovirus vectors for gene transduction into mobilized blood CD34+ cells. Gene Ther 5:465-472; Dietz, A. B., and Vuk-Pavlovic, S. 1998. High efficiency adenovirus-mediated gene transfer to human dendritic cells. Blood 91:392-398; Ishida, T., Chada, S., Stipanov, M., Nadaf, S., Ciernik, F. I., Gabrilovich, D. I., and Carbone, D. P. 1999. Dendritic cells transduced with wild-type p53 gene elicit potent anti-tumour immune responses. Clin Exp Immunol 117:244-251; Ribas, A., Butterfield, L. H., McBride, W. H., Jilani, S. M., Bui, L. A., Vollmer, C. M., Lau, R., Dissette, V. B., Hu, B., Chen, A. Y., et al. 1997. Genetic immunization for the melanoma antigen MART-1/Melan-A using recombinant adenovirus-transduced murine dendritic cells. Cancer Res 57:2865-2869). Immunization of animals with DC's previously transduced by Ad5 vectors encoding tumor specific antigens has been demonstrated to result in significant levels of protection for the animals when challenged with tumor cells expressing the respective antigen (Wan, Y., Bramson, J., Carter, R., Graham, F., and Gauldie, J. 1997. Dendritic cells transduced with an adenoviral vector encoding a model tumor-associated antigen for tumor vaccination. Hum Gene Ther 8:1355-1363; Wan, Y., Emtage, P., Foley, R., Carter, R., and Gauldie, J. 1999. Murine dendritic cells transduced with an adenoviral vector expressing a defined tumor antigen can overcome anti-adenovirus neutralizing immunity and induce effective tumor regression. Int J Oncol 14:771-776). Interestingly, intra-tumoral injection of Ads encoding IL-7 was less effective than injection of DCs transduced with IL-7 encoding Ad5 vectors at inducing antitumor immunity, further heightening the interest in ex vivo transduction of DCs by Ad5 vectors (Miller, P. W., Sharma, S., Stolina, M., Butterfield, L. H., Luo, J., Lin, Y., Dohadwala, M., Batra, R. K., Wu, L., Economou, J. S., et al. 2000. Intratumoral administration of adenoviral interleukin 7 gene-modified dendritic cells augments specific antitumor immunity and achieves tumor eradication. Hum Gene Ther 11:53-65). Ex vivo DC transduction strategies have also been used to attempt to induce tolerance in recipient hosts, for example, by Ad5 mediated delivery of the CTLA4Ig into DCs, blocking interactions of the DCs CD80 with the CD28 molecule present on T-cells (Lu, L., Gambotto, A., Lee, W. C., Qian, S., Bonham, C. A., Robbins, P. D., and Thomson, A. W. 1999. Adenoviral delivery of CTLA4Ig into myeloid dendritic cells promotes their in vitro tolerogenicity and survival in allogeneic recipients. Gene Ther 6:554-563).

Ad5 vector capsid interactions with DCs in and of themselves may trigger several beneficial responses, which may be enhancing the propensity of DCs to present antigens encoded by Ad5 vectors. For example, immature DCs, though specialized in antigen uptake, are relatively inefficient effectors of T-cell activation. DC maturation coincides with the enhanced ability of DCs to drive T-cell immunity. In some instances, the compositions and methods of the invention take advantage of an Ad5 infection resulting in direct induction of DC maturation (Rea, D., Schagen, F. H., Hoeben, R. C., Mehtali, M., Havenga, M. J., Toes, R. E., Melief, C. J., and Offringa, R. 1999. Adenoviruses activate human dendritic cells without polarization toward a T-helper type 1-inducing subset. J Virol 73:10245-10253; Hirschowitz, E. A., Weaver, J. D., Hidalgo, G. E., and Doherty, D. E. 2000. Murine dendritic cells infected with adenovirus vectors show signs of activation. Gene Ther 7:1112-1120). Studies of immature bone marrow derived DCs from mice suggest that Ad vector infection of immature bone marrow derived DCs from mice resulted may upregulate cell surface markers normally associated with DC maturation (MHC I and II, CD40, CD80, CD86, and ICAM-1) as well as down-regulation of CD11c, an integrin known to be down regulated upon myeloid DC maturation. In some instances, Ad vector infection triggers IL-12 production by DCs, a marker of DC maturation (Hirschowitz, E. A., Weaver, J. D., Hidalgo, G. E., and Doherty, D. E. 2000. Murine dendritic cells infected with adenovirus vectors show signs of activation. Gene Ther 7:1112-1120). Without being bound by theory, these events may possibly be due to Ad5 triggered activation of NF-κB pathways (Hirschowitz, E. A., Weaver, J. D., Hidalgo, G. E., and Doherty, D. E. 2000. Murine dendritic cells infected with adenovirus vectors show signs of activation. Gene Ther 7:1112-1120; Loser, P., Jennings, G. S., Strauss, M., and Sandig, V. 1998. Reactivation of the previously silenced cytomegalovirus major immediate-early promoter in the mouse liver: involvement of NF-κB. J Virol 72:180-190; Morelli, A. E., Larregina, A. T., Ganster, R. W., Zahorchak, A. F., Plowey, J. M., Takayama, T., Logar, A. J., Robbins, P. D., Falo, L. D., and Thomson, A. W. 2000. Recombinant adenovirus induces maturation of dendritic cells via an NF-κB-dependent pathway. J Virol 74:9617-9628). Mature DCs can be efficiently transduced by Ad vectors, and did not lose their functional potential to stimulate the proliferation of naive T-cells at lower MOI, as demonstrated by mature CD83+ human DC (derived from peripheral blood monocytes. However, mature DCs may also be less infectable than immature ones (Rea, D., Schagen, F. H., Hoeben, R. C., Mehtali, M., Havenga, M. J., Toes, R. E., Melief, C. J., and Offringa, R. 1999. Adenoviruses activate human dendritic cells without polarization toward a T-helper type 1-inducing subset. J Virol 73:10245-10253; Jonuleit, H., Tüting, T., Steitz, J., Bruck, J., Giesecke, A., Steinbrink, K., Knop, J., and Enk, A. H. 2000. Efficient transduction of mature CD83+ dendritic cells using recombinant adenovirus suppressed T cell stimulatory capacity. Gene Ther 7:249-254). Modification of capsid proteins can be used as a strategy to optimize infection of DC by Ad vectors, as well as enhancing functional maturation, for example using the CD40L receptor as a viral vector receptor, rather than using the normal CAR receptor infection mechanisms (Tillman, B. W., Hayes, T. L., DeGruijl, T. D., Douglas, J. T., and Curiel, D. T. 2000. Adenoviral vectors targeted to CD40 enhance the efficacy of dendritic cell-based vaccination against human papillomavirus 16-induced tumor cells in a murine model. Cancer Res 60:5456-5463).

Most dramatically, when the potential of non-viral vectors to induce anti-HIV immune responses was directly compared to Ad5 based vectoring systems, the Ad5 based systems were found to be far superior (Shiver, J. W., Fu, T. M., Chen, L., Casimiro, D. R., Davies, M. E., Evans, R. K., Zhang, Z. Q., Simon, A. J., Trigona, W. L., Dubey, S. A., et al. 2002. Replication-incompetent adenoviral vaccine vector elicits effective anti-immunodeficiency-virus immunity. Nature 415:331-335). For example, in Ad5 naïve primate models, vaccination with a Ad5 [E1-] expressing the HIV gag was superior in protecting the animals from SHIV infections as compared to similar efforts utilizing naked DNA vaccines expressing HIV-gag. Thus, viral vectors can be superior to naked DNA approaches (Shiver, J. W., Fu, T. M., Chen, L., Casimiro, D. R., Davies, M. E., Evans, R. K., Zhang, Z. Q., Simon, A. J., Trigona, W. L., Dubey, S. A., et al. 2002. Replication-incompetent adenoviral vaccine vector elicits effective anti-immunodeficiency-virus immunity. Nature 415:331-335). Combined strategies (building upon their clinical experiences with naked DNA-gag vectors alone) using naked DNA-gag vaccines as a priming vaccination, followed by boosting with the Ad5 [E1-]-gag vaccine further improved T cell responses in human trials than those previously noted with the DNA-HIV-gag encoding vector alone (HVTN working group meeting, Alexandria, Va.: 2002).

In summary, Ad5 vectors appear to offer a unique opportunity to allow for high level and efficient transduction of TAAs such as CEA. One of the major problems facing Ad5 based vectors is the high propensity of pre-existing immunity to Ads in the human population, and how this may preclude the use of conventional, Ad5 [E1-] deleted (first generation Ads) in most human populations, for any additional vaccine application.

Ad5 [E1-, E2B-]-CEA(6D) Vaccine: The Use of Ad5 [E1-, E2b-] Vaccines to Overcome the Challenge of Pre-Existing Anti-Ad5 Immunity

Studies in humans and animals have demonstrated that pre-existing immunity against Ad5 can be an inhibitory factor to commercial use of Ad-based vaccines (Yang, Z. Y., Wyatt, L. S., Kong, W. P., Moodie, Z., Moss, B., and Nabel, G. J. 2003. Overcoming immunity to a viral vaccine by DNA priming before vector boosting. J Virol 77:799-803; Casimiro, D. R., Chen, L., Fu, T. M., Evans, R. K., Caulfield, M. J., Davies, M. E., Tang, A., Chen, M., Huang, L., Harris, V., et al. 2003. Comparative immunogenicity in rhesus monkeys of DNA plasmid, recombinant vaccinia virus, and replication-defective adenovirus vectors expressing a human immunodeficiency virus type 1 gag gene. J Virol 77:6305-6313). The preponderance of humans have antibody against Ad5, the most widely used subtype for human vaccines, with two-thirds of humans studied having lympho-proliferative responses against Ad5 (Chirmule, N., Propert, K., Magosin, S., Qian, Y., Qian, R., and Wilson, J. 1999. Immune responses to adenovirus and adeno-associated virus in humans. Gene Ther 6:1574-1583). This pre-existing immunity can inhibit immunization or re-immunization using typical Ad5 vaccines and may preclude the immunization of a vaccinee against a second antigen, using an Ad5 vector, at a later time. Overcoming the problem of pre-existing anti-vector immunity has been a subject of intense investigation. Investigations using alternative human (non-Ad5 based) Ad5 subtypes or even non-human forms of Ad5 have been examined. Even if these approaches succeed in an initial immunization, subsequent vaccinations may be problematic due to immune responses to the novel Ad5 subtype. To avoid the Ad5 immunization barrier, and improve upon the limited efficacy of first generation Ad5 [E1-] vectors to induce optimal immune responses, various embodiments of the invention relate to a next generation Ad5 vector based vaccine platform. The new Ad5 platform has additional deletions in the E2b region, removing the DNA polymerase and the preterminal protein genes. The Ad5 [E1-, E2b-] platform has an expanded cloning capacity that is sufficient to allow inclusion of many possible genes (Hartigan-O'Connor, D., Barjot, C., Salvatori, G., and Chamberlain, J. S. 2002. Generation and growth of gutted adenoviral vectors. Methods Enzymol 346:224-246). Ad5 [E1-, E2b-] vectors have up to about 12 kb gene-carrying capacity as compared to the 7 kb capacity of Ad5 [E1-] vectors, providing space for multiple genes if needed. In some embodiments, an insert of more than 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 11 kb is introduced into an Ad5 vector, such as the Ad5 [E1-, E2b-] vector. Deletion of the E2b region confers advantageous immune properties on the Ad5 vectors of the invention, often eliciting potent immune responses to target transgene antigens while minimizing the immune responses to Ad viral proteins.

In various embodiments, Ad5 [E1-, E2b-] vectors of the invention induce a potent CMI, as well as antibodies against the vector expressed vaccine antigens even in the presence of Ad immunity (Harui, A., Roth, M. D., Kiertscher, S. M., Mitani, K., and Basak, S. K. 2004. Vaccination with helper-dependent adenovirus enhances the generation of transgene-specific CTL. Gene Ther 11:1617-1626). Ad5 [E1-, E2b-] vectors also have reduced adverse reactions as compared to Ad5 [E1-] vectors, in particular the appearance of hepatotoxicity and tissue damage (Hodges, B. L., Serra, D., Hu, H., Begy, C. A., Chamberlain, J. S., and Amalfitano, A. 2000. Multiply deleted [E1, polymerase-, and pTP-] adenovirus vector persists despite deletion of the preterminal protein. J Gene Med 2:250-259; Morral, N., Parks, R. J., Zhou, H., Langston, C., Schiedner, G., Quinones, J., Graham, F. L., Kochanek, S., and Beaudet, A. L. 1998. High doses of a helper-dependent adenoviral vector yield supraphysiological levels of alpha1-antitrypsin with negligible toxicity. Hum Gene Ther 9:2709-2716; DelloRusso, C., Scott, J. M., Hartigan-O'Connor, D., Salvatori, G., Barjot, C., Robinson, A. S., Crawford, R. W., Brooks, S. V., and Chamberlain, J. S. 2002. Functional correction of adult mdx mouse muscle using gutted adenoviral vectors expressing full-length dystrophin. Proc Natl Acad Sci USA 99:12979-12984; Reddy, P. S., Sakhuja, K., Ganesh, S., Yang, L., Kayda, D., Brann, T., Pattison, S., Golightly, D., Idamakanti, N., Pinkstaff, A., et al. 2002. Sustained human factor VIII expression in hemophilia A mice following systemic delivery of a gutless adenoviral vector. Mol Ther 5:63-73). A key aspect of these Ad5 vectors is that expression of Ad late genes is greatly reduced (Hodges, B. L., Serra, D., Hu, H., Begy, C. A., Chamberlain, J. S., and Amalfitano, A. 2000. Multiply deleted [E1, polymerase-, and pTP-] adenovirus vector persists despite deletion of the preterminal protein. J Gene Med 2:250-259; Amalfitano, A., Hauser, M. A., Hu, H., Serra, D., Begy, C. R., and Chamberlain, J. S. 1998. Production and characterization of improved adenovirus vectors with the E1, E2b, and E3 genes deleted. J Virol 72:926-933; Hartigan-O'Connor, D., Kirk, C. J., Crawford, R., Mulé, J. J., and Chamberlain, J. S. 2001. Immune evasion by muscle-specific gene expression in dystrophic muscle. Mol Ther 4:525-533). For example, production of the capsid fiber proteins could be detected in vivo for Ad5 [E1-] vectors, while fiber expression was ablated from Ad5 [E1-, E2b-] vector vaccines (Hu, H., Serra, D., and Amalfitano, A. 1999. Persistence of an [E1-, polymerase-] adenovirus vector despite transduction of a neoantigen into immune-competent mice. Hum Gene Ther 10:355-364; DelloRusso, C., Scott, J. M., Hartigan-O'Connor, D., Salvatori, G., Barjot, C., Robinson, A. S., Crawford, R. W., Brooks, S. V., and Chamberlain, J. S. 2002. Functional correction of adult mdx mouse muscle using gutted adenoviral vectors expressing full-length dystrophin. Proc Natl Acad Sci USA 99:12979-12984; Reddy, P. S., Sakhuja, K., Ganesh, S., Yang, L., Kayda, D., Brann, T., Pattison, S., Golightly, D., Idamakanti, N., Pinkstaff, A., et al. 2002. Sustained human factor VIII expression in hemophilia A mice following systemic delivery of a gutless adenoviral vector. Mol Ther 5:63-73). The innate immune response to wild type Ad is complex. Proteins deleted from the Ad5 [E1-, E2b-] vectors generally play an important role. Specifically, Ad5 [E1-, E2b-] vectors with deletions of preterminal protein or DNA polymerase display reduced inflammation during the first 24 to 72 hours following injection compared to Ad5 [E1-] vectors. In various embodiments, the lack of Ad5 gene expression renders infected cells invisible to anti-Ad activity and permits infected cells to express the transgene for extended periods of time, which develops immunity to the target.

Various embodiments of the invention contemplate increasing the capability for the Ad5 [E1-, E2b-] vectors to transduce dendritic cells, improving antigen specific immune responses in the vaccine by taking advantage of the reduced inflammatory response against Ad5 [E1-, E2b-] vector viral proteins and the resulting evasion of pre-existing Ad immunity.

In some cases, this immune induction may take months. Ad5 [E1-, E2b-] vectors not only are safer than, but appear to be superior to Ad5 [E1-] vectors in regard to induction of antigen specific immune responses, making them much better suitable as a platform to deliver CEA vaccines that can result in a clinical response.

Various embodiments of the invention, by taking advantage of the new Ad5 [E1-, E2b-] vector system in delivering a long sought-after need for a develop a therapeutic vaccine against CEA, overcome barriers found with other Ad5 systems and permit the immunization of people who have previously been exposed to Ad5.

In various embodiments the compositions and methods of the invention comprising an Ad5 [E1-, E2b-] vector CEA vaccine effect of increased overall survival (OS) within the bounds of technical safety.

Adenovirus Vectors

Compared to First Generation adenovirus vectors, certain embodiments of the Second Generation E2b deleted adenovirus vectors of the present invention contain additional deletions in the DNA polymerase gene (pol) and deletions of the pre-terminal protein (pTP). E2b deleted vectors have up to a 13 kb gene-carrying capacity as compared to the 5 to 6 kb capacity of First Generation adenovirus vectors, easily providing space for nucleic acid sequences encoding any of a variety of target antigens. The E2b deleted adenovirus vectors also have reduced adverse reactions as compared to First Generation adenovirus vectors (Morral, et al Hum Gene Ther 9/2709-2716 (1998); Hodges, et al. J Gene Med 2/250-259 (2000); DelloRusso, et al. Proc Natl Acad Sci USA 99/12979-12984 (2002); Reddy, et al. Mol Ther 5/63-73 (2002); (Amalfitano and Parks, et al. Curr Gene Ther 2/111-133 (2002); Amalfitano Curr Opin Mol Ther 5/362-366 (2003); Everett, et al. Human Gene Ther 14/1715-1726 (2003)) E2b deleted vectors have reduced expression of viral genes (Hodges, et al. J Gene Med 2/250-259 (2000); Amalfitano, et al. J Virol 72/926-933 (1998); Hartigan-O'Connor, et al. Mol Ther 4/525-533 (2001)), and this characteristic has been reported to lead to extended transgene expression in vivo (Hu, et al. Hum Gene Ther 10/355-364 (1999); DelloRusso, et al. Proc Natl Acad Sci USA 99/12979-12984 (2002); Reddy, et al. Mol Ther 5/63-73 (2002); (Amalfitano and Parks, et al. Curr Gene Ther 2/111-133 (2002); Amalfitano Curr Opin Mol Ther 5/362-366 (2003); Everett, et al. Human Gene Ther 14/1715-1726 (2003)).

The innate immune response to wild type Ad can be complex, and it appears that Ad proteins expressed from adenovirus vectors play an important role (Moorhead, et al. J Virol 73/1046-1053 (1999); Nazir, et al. J Investig Med 53/292-304 (2005); Schaack, et al. Proc Natl Acad Sci USA 101/3124-3129 (2004); Schaack, et al. Viral Immunol 18/79-88 (2005); Kiang, et al. Mol Ther 14/588-598 (2006); Hartman, et al. J Virol 81/1796-1812 (2007); Hartman, et al. Virology 358/357-372 (2007)). Specifically, the deletions of pre-terminal protein and DNA polymerase in the E2b deleted vectors appear to reduce inflammation during the first 24 to 72 hours following injection, whereas First Generation adenovirus vectors stimulate inflammation during this period (Schaack, et al. Proc Natl Acad Sci USA 101/3124-3129 (2004); Schaack, et al. Viral Immunol 18/79-88 (2005); Kiang, et al. Mol Ther 14/588-598 (2006); Hartman, et al. J Virol 81/1796-1812 (2007); Hartman, et al. Virology 358/357-372 (2007)). In addition, it has been reported that the additional replication block created by E2b deletion also leads to a 10,000 fold reduction in expression of Ad late genes, well beyond that afforded by E1, E3 deletions alone (Amalfitano et al. J. Virol. 72/926-933 (1998); Hodges et al. J. Gene Med. 2/250-259 (2000)). The decreased levels of Ad proteins produced by E2b deleted adenovirus vectors effectively reduce the potential for competitive, undesired, immune responses to Ad antigens, responses that prevent repeated use of the platform in Ad immunized or exposed individuals. The reduced induction of inflammatory response by Second Generation E2b deleted vectors results in increased potential for the vectors to express desired vaccine antigens during the infection of antigen presenting cells (i.e. dendritic cells), decreasing the potential for antigenic competition, resulting in greater immunization of the vaccine to the desired antigen relative to identical attempts with First Generation adenovirus vectors. E2b deleted adenovirus vectors provide an improved Ad-based vaccine candidate that is safer, more effective, and more versatile than previously described vaccine candidates using First Generation adenovirus vectors.

Thus, first generation, E1-deleted Adenovirus subtype 5 (Ad5)-based vectors, although promising platforms for use as cancer vaccines, are impeded in activity by naturally occurring or induced Ad-specific neutralizing antibodies. Without being bound by theory, Ad5-based vectors with deletions of the E1 and the E2b regions (Ad5 [E1-, E2b-]), the latter encoding the DNA polymerase and the pre-terminal protein, for example by virtue of diminished late phase viral protein expression, may avoid immunological clearance and induce more potent immune responses against the encoded tumor antigen transgene in Ad-immune hosts. Indeed, multiple homologous immunizations with Ad5 [E1-, E2b-]-CEA(6D), encoding the tumor antigen CEA, induced CEA-specific cell-mediated immune (CMI) responses with antitumor activity in mice despite the presence of pre-existing or induced Ad5-neutralizing antibody. In the present phase I/II study, cohorts of patients with advanced colorectal cancer were immunized with escalating doses of Ad5 [E1-, E2b-]-CEA(6D). CEA-specific CMI responses were observed despite the presence of pre-existing Ad5 immunity in a majority (61.3%) of patients. Importantly, there was minimal toxicity, and overall patient survival (48% at 12 months) was similar regardless of pre-existing Ad5 neutralizing antibody titers. The results demonstrate that, in cancer patients, the novel Ad5 [E1-, E2b-] gene delivery platform generates significant CMI responses to the tumor antigen CEA in the setting of both naturally acquired and immunization-induced Ad5 specific immunity.

The present invention contemplates the use of E2b deleted adenovirus vectors, such as those described in U.S. Pat. Nos. 6,063,622; 6,451,596; 6,057,158; 6,083,750; and 8,298,549, which are each incorporated herein by reference in their entirety. The vectors with deletions in the E2b regions in many cases cripple viral protein expression and/or decrease the frequency of generating replication competent Ad (RCA). Propagation of these E2b deleted adenovirus vectors can be done utilizing cell lines that express the deleted E2b gene products. The present invention also provides such packaging cell lines; for example E.C7 (formally called C-7), derived from the HEK-203 cell line (Amalfitano, et al. Proc Natl Acad Sci USA 93/3352-3356 (1996); Amalfitano, et al. Gene Ther 4/258-263 (1997)).

Further, the E2b gene products, DNA polymerase and preterminal protein, can be constitutively expressed in E.C7, or similar cells along with the E1 gene products. Transfer of gene segments from the Ad genome to the production cell line has immediate benefits: (1) increased carrying capacity; and, (2) a decreased potential of RCA generation, typically requiring two or more independent recombination events to generate RCA. The E1, Ad DNA polymerase and/or preterminal protein expressing cell lines used in the present invention can enable the propagation of adenovirus vectors with a carrying capacity approaching 13 kb, without the need for a contaminating helper virus [Mitani et al. (1995) Proc. Natl. Acad. Sci. USA 92:3854; Hodges, et al., 2000 J Gene Med 2:250-259; (Amalfitano and Parks, Curr Gene Ther 2/111-133 (2002)]. In addition, when genes critical to the viral life cycle are deleted (e.g., the E2b genes), a further crippling of Ad to replicate or express other viral gene proteins occurs. This can decrease immune recognition of virally infected cells, and allow for extended durations of foreign transgene expression.

E1, DNA polymerase, and preterminal protein deleted vectors are typically unable to express the respective proteins from the E1 and E2b regions. Further, they may show a lack of expression of most of the viral structural proteins. For example, the major late promoter (MLP) of Ad is responsible for transcription of the late structural proteins L1 through L5 [Doerfler, In Adenovirus DNA, The Viral Genome and Its Expression (Martinus Nijhoff Publishing Boston, 1986)]. Though the MLP is minimally active prior to Ad genome replication, the highly toxic Ad late genes are primarily transcribed and translated from the MLP only after viral genome replication has occurred [Thomas and Mathews (1980) Cell 22:523]. This cis-dependent activation of late gene transcription is a feature of DNA viruses in general, such as in the growth of polyoma and SV-40. The DNA polymerase and preterminal proteins are important for Ad replication (unlike the E4 or protein IX proteins). Their deletion can be extremely detrimental to adenovirus vector late gene expression, and the toxic effects of that expression in cells such as APCs.

In certain embodiments, the adenovirus vectors contemplated for use in the present invention include E2b deleted adenovirus vectors that have a deletion in the E2b region of the Ad genome and, optionally, the E1 region. In some cases, such vectors do not have any other regions of the Ad genome deleted. In another embodiment, the adenovirus vectors contemplated for use in the present invention include E2b deleted adenovirus vectors that have a deletion in the E2b region of the Ad genome and, optionally, deletions in the E1 and E3 regions. In some cases, such vectors have no other regions deleted. In a further embodiment, the adenovirus vectors contemplated for use in the present invention include adenovirus vectors that have a deletion in the E2b region of the Ad genome and, optionally, deletions in the E1, E3 and, also optionally, partial or complete removal of the E4 regions. In some cases, such vectors have no other deletions. In another embodiment, the adenovirus vectors contemplated for use in the present invention include adenovirus vectors that have a deletion in the E2b region of the Ad genome and, optionally deletions in the E1 and/or E4 regions. In some cases, such vectors contain no other deletions. In an additional embodiment, the adenovirus vectors contemplated for use in the present invention include adenovirus vectors that have a deletion in the E2a, E2b and/or E4 regions of the Ad genome. In some cases, such vectors have no other deletions. In one embodiment, the adenovirus vectors for use herein comprise vectors having the E1 and/or DNA polymerase functions of the E2b region deleted. In some cases, such vectors have no other deletions. In a further embodiment, the adenovirus vectors for use herein have the E1 and/or the preterminal protein functions of the E2b region deleted. In some cases, such vectors have no other deletions. In another embodiment, the adenovirus vectors for use herein have the E1, DNA polymerase and/or the preterminal protein functions deleted. In some cases, such vectors have no other deletions. In one particular embodiment, the adenovirus vectors contemplated for use herein are deleted for at least a portion of the E2b region and/or the E1 region. In some cases, such vectors are not “gutted” adenovirus vectors. In this regard, the vectors may be deleted for both the DNA polymerase and the preterminal protein functions of the E2b region. In an additional embodiment, the adenovirus vectors for use in the present invention include adenovirus vectors that have a deletion in the E1, E2b and/or 100K regions of the adenovirus genome. In one embodiment, the adenovirus vectors for use herein comprise vectors having the E1, E2b and/or protease functions deleted. In some cases, such vectors have no other deletions. In a further embodiment, the adenovirus vectors for use herein have the E1 and/or the E2b regions deleted, while the fiber genes have been modified by mutation or other alterations (for example to alter Ad tropism). Removal of genes from the E3 or E4 regions may be added to any of the mentioned adenovirus vectors. In certain embodiments, the adenovirus vector may be a “gutted” adenovirus vector.

The term “E2b deleted”, as used herein, refers to a specific DNA sequence that is mutated in such a way so as to prevent expression and/or function of at least one E2b gene product. Thus, in certain embodiments, “E2b deleted” is used in relation to a specific DNA sequence that is deleted (removed) from the Ad genome. E2b deleted or “containing a deletion within the E2b region” refers to a deletion of at least one base pair within the E2b region of the Ad genome. Thus, in certain embodiments, more than one base pair is deleted and in further embodiments, at least 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, or 150 base pairs are deleted. In another embodiment, the deletion is of more than 150, 160, 170, 180, 190, 200, 250, or 300 base pairs within the E2b region of the Ad genome. An E2b deletion may be a deletion that prevents expression and/or function of at least one E2b gene product and therefore, encompasses deletions within exons of encoding portions of E2b-specific proteins as well as deletions within promoter and leader sequences. In certain embodiments, an E2b deletion is a deletion that prevents expression and/or function of one or both of the DNA polymerase and the preterminal protein of the E2b region. In a further embodiment, “E2b deleted” refers to one or more point mutations in the DNA sequence of this region of an Ad genome such that one or more encoded proteins is non-functional. Such mutations include residues that are replaced with a different residue leading to a change in the amino acid sequence that result in a nonfunctional protein.

The term “E1 deleted”, as used herein, refers to a specific DNA sequence that is mutated in such a way so as to prevent expression and/or function of at least one E1 gene product. Thus, in certain embodiments, “E1 deleted” is used in relation to a specific DNA sequence that is deleted (removed) from the Ad genome. E1 deleted or “containing a deletion within the E1 region” refers to a deletion of at least one base pair within the E1 region of the Ad genome. Thus, in certain embodiments, more than one base pair is deleted and in further embodiments, at least 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, or 150 base pairs are deleted. In another embodiment, the deletion is of more than 150, 160, 170, 180, 190, 200, 250, or 300 base pairs within the E1 region of the Ad genome. An E1 deletion may be a deletion that prevents expression and/or function of at least one E1 gene product and therefore, encompasses deletions within exons of encoding portions of E1-specific proteins as well as deletions within promoter and leader sequences. In certain embodiments, an E1 deletion is a deletion that prevents expression and/or function of one or both of a trans-acting transcriptional regulatory factor of the E1 region. In a further embodiment, “E1 deleted” refers to one or more point mutations in the DNA sequence of this region of an Ad genome such that one or more encoded proteins is non-functional. Such mutations include residues that are replaced with a different residue leading to a change in the amino acid sequence that result in a nonfunctional protein.

As would be understood by the skilled artisan upon reading the present disclosure, other regions of the Ad genome can be deleted. Thus to be “deleted” in a particular region of the Ad genome, as used herein, refers to a specific DNA sequence that is mutated in such a way so as to prevent expression and/or function of at least one gene product encoded by that region. In certain embodiments, to be “deleted” in a particular region refers to a specific DNA sequence that is deleted (removed) from the Ad genome in such a way so as to prevent the expression and/or the function encoded by that region (e.g., E2b functions of DNA polymerase or preterminal protein function). “Deleted” or “containing a deletion” within a particular region refers to a deletion of at least one base pair within that region of the Ad genome. Thus, in certain embodiments, more than one base pair is deleted and in further embodiments, at least 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, 120, 130, 140, or 150 base pairs are deleted from a particular region. In another embodiment, the deletion is more than 150, 160, 170, 180, 190, 200, 250, or 300 base pairs within a particular region of the Ad genome. These deletions are such that expression and/or function of the gene product encoded by the region is prevented. Thus deletions encompass deletions within exons encoding portions of proteins as well as deletions within promoter and leader sequences. In a further embodiment, “deleted” in a particular region of the Ad genome refers to one or more point mutations in the DNA sequence of this region of an Ad genome such that one or more encoded proteins is non-functional. Such mutations include residues that are replaced with a different residue leading to a change in the amino acid sequence that result in a nonfunctional protein. Deletions or mutations in the Ad genome can be within one or more of E1a, E1b, E2a, E2b, E3, E4, L1, L2, L3, L4, L5, TP, POL, IV, and VA regions.

The deleted adenovirus vectors of the present invention can be generated using recombinant techniques known in the art (see e.g., Amalfitano et al., 1998 J. Virol. 72:926-933; Hodges, et al., 2000 J Gene Med 2:250-259).

As would be recognized by the skilled artisan, the adenovirus vectors for use in the present invention can be successfully grown to high titers using an appropriate packaging cell line that constitutively expresses E2b gene products and products of any of the necessary genes that may have been deleted. In certain embodiments, HEK-293-derived cells that not only constitutively express the E1 and DNA polymerase proteins, but also the Ad-preterminal protein, can be used. In one embodiment, E.C7 cells are used to successfully grow high titer stocks of the adenovirus vectors (see e.g., Amalfitano et al., J. Virol. 1998 72:926-933; Hodges, et al. J Gene Med 2/250-259 (2000)).

In order to delete critical genes from self-propagating adenovirus vectors, the proteins encoded by the targeted genes can first be coexpressed in HEK-293 cells, or similar, along with the E1 proteins. For example, only those proteins which are non-toxic when coexpressed constitutively (or toxic proteins inducibly-expressed) can be selectively utilized. Coexpression in HEK-293 cells of the E1 and E4 genes is possible (for example utilizing inducible, not constitutive, promoters) according to the methods in Yeh et al. (1996) J. Virol. 70:559; Wang et al. (1995) Gene Therapy 2:775; and Gorziglia et al. (1996) J. Virol. 70:4173. The E1 and protein IX genes, a virion structural protein, can be coexpressed [Caravokyri and Leppard (1995) J. Virol. 69:6627. Further coexpression of the E1, E4, and protein IX genes is also possible as described in Krougliak and Graham (1995) Hum. Gene Ther. 6:1575. The E1 and 100 k genes can be successfully expressed in transcomplementing cell lines, as can E1 and protease genes (Oualikene, et al. Hum Gene Ther 11/1341-1353 (2000); Hodges, et al. J. Virol 75/5913-5920 (2001)).

Cell lines coexpressing E1 and E2b gene products for use in growing high titers of E2b deleted Ad particles are described in U.S. Pat. No. 6,063,622. The E2b region encodes viral replication proteins, which are essential for Ad genome replication [Doerfler, supra and Pronk et al. (1992) Chromosoma 102:S39-545]. Useful cell lines constitutively express the approximately 140 kD Ad-DNA polymerase and/or the approximately 90 kD preterminal protein. In particular, cell lines that have high-level, constitutive coexpression of the E1, DNA polymerase, and preterminal proteins, without toxicity (e.g. E.C7), are desirable for use in propagating Ad for use in multiple vaccinations. These cell lines permit the propagation of adenovirus vectors deleted for the E1, DNA polymerase, and preterminal proteins.

The recombinant Ad of the present invention can be propagated using techniques known in the art. For example, tissue culture plates containing E.C7 cells can be infected with the adenovirus vector virus stocks at an appropriate MOI (e.g., 5) and incubated at 37.0.degree. C. for 40-96 h. The infected cells can be harvested, resuspended in 10 mM Tris-Cl (pH 8.0), and sonicated, and the virus is purified by two rounds of cesium chloride density centrifugation. In certain techniques, the virus containing band is desalted over a Sephadex CL-6B column (Pharmacia Biotech, Piscataway, N.J.), sucrose or glycerol is added, and aliquots are stored at −80.degree. C. In some embodiments, the virus is placed in a solution designed to enhance its stability, such as A195 (Evans, et al. J Pharm Sci 93/2458-2475 (2004)). The titer of the stock can be measured (e.g., by measurement of the optical density at 260 nm of an aliquot of the virus after SDS lysis). In another embodiment, plasmid DNA, either linear or circular, encompassing the entire recombinant E2b deleted adenovirus vector is transfected into E.C7, or similar cells, and incubated at 37.0.degree. C. until evidence of viral production is present (e.g. the cytopathic effect). The conditioned media from these cells can be used to infect more E.C7, or similar cells, to expand the amount of virus produced, before purification. Purification can be accomplished, for example, by two rounds of cesium chloride density centrifugation or selective filtration. In certain embodiments, the virus may be purified by column chromatography, using commercially available products (e.g. Adenopure from Puresyn, Inc., Malvern, Pa.) or custom made chromatographic columns.

Generally, the compositions of the present invention comprises enough of the virus to ensure that the cells to be infected are confronted with a certain number of viruses. Thus, in various embodiments, the present invention provides a stock of recombinant Ad, preferably an RCA-free stock of recombinant Ad. The preparation and analysis of Ad stocks is well known in the art. Viral stocks can vary considerably in titer, depending largely on viral genotype and the protocol and cell lines used to prepare them. The viral stocks of the present invention can have a titer of at least about 10⁶, 10⁷, or 10⁸ pfu/ml, and many such stocks can have higher titers, such as at least about 10⁹, 10¹⁰, 10¹¹, or 10¹² pfu/ml. Depending on the nature of the recombinant virus and the packaging cell line, it is possible that a viral stock of the present invention can have a titer of even about 10¹³ particles/ml or higher.

Further information on viral delivery systems is known in the art and can be found, for example, in Fisher-Hoch et al., Proc. Natl. Acad. Sci. USA 86:317-321, 1989; Flexner et al., Ann. N.Y. Acad. Sci. 569:86-103, 1989; Flexner et al., Vaccine 8:17-21, 1990; U.S. Pat. Nos. 4,603,112, 4,769,330, and 5,017,487; WO 89/01973; U.S. Pat. No. 4,777,127; GB 2,200,651; EP 0,345,242; WO 91/02805; Berkner, Biotechniques 6:616-627, 1988; Rosenfeld et al., Science 252:431-434, 1991; Kolls et al., Proc. Natl. Acad. Sci. USA 91:215-219, 1994; Kass-Eisler et al., Proc. Natl. Acad. Sci. USA 90:11498-11502, 1993; Guzman et al., Circulation 88:2838-2848, 1993; and Guzman et al., Cir. Res. 73:1202-1207, 1993, which are each herein incorporated by reference in their entirety.

Heterologous Nucleic Acid

The adenovirus vectors of the present invention typically comprise heterologous nucleic acid sequences that encode one or more target antigens of interest, or variants, fragments or fusions thereof, against which it is desired to generate an immune response. In some embodiments, the adenovirus vectors of the present invention comprise heterologous nucleic acid sequences that encode one or more proteins, variants thereof, fusions thereof, or fragments thereof, that can modulate the immune response. In a further embodiment of the invention, the adenovirus vector of the present invention encodes one or more antibodies against specific antigens, such as anthrax protective antigen, permitting passive immunotherapy. In certain embodiments, the adenovirus vectors of the present invention comprise heterologous nucleic acid sequences encoding one or more proteins having therapeutic effect (e.g., anti-viral, anti-bacterial, anti-parasitic, or anti-tumor function). Thus the present invention provides the Second Generation E2b deleted adenovirus vectors that comprise a heterologous nucleic acid sequence. In some embodiments, the heterologous nucleic acid sequence is colorectal embryonic antigen (CEA) or a variant, a part, or a variant part thereof.

As such, the present invention further provides nucleic acid sequences, also referred to herein as polynucleotides, that encode one or more target antigens of interest, or fragments or variants thereof. As such, the present invention provides polynucleotides that encode target antigens from any source as described further herein, vectors comprising such polynucleotides and host cells transformed or transfected with such expression vectors. The terms “nucleic acid” and “polynucleotide” are used essentially interchangeably herein. As will be also recognized by the skilled artisan, polynucleotides of the invention may be single-stranded (coding or antisense) or double-stranded, and may be DNA (e.g. genomic, cDNA, or synthetic) or RNA molecules. RNA molecules may include HnRNA molecules, which contain introns and correspond to a DNA molecule in a one-to-one manner, and mRNA molecules, which do not contain introns. Additional coding or non-coding sequences may, but need not, be present within a polynucleotide of the present invention, and a polynucleotide may, but need not, be linked to other molecules and/or support materials. An isolated polynucleotide, as used herein, means that a polynucleotide is substantially away from other coding sequences. For example, an isolated DNA molecule as used herein does not contain large portions of unrelated coding DNA, such as large chromosomal fragments or other functional genes or polypeptide coding regions. This refers to the DNA molecule as originally isolated, and does not exclude genes or coding regions later added to the segment recombinantly in the laboratory.

As will be understood by those skilled in the art, the polynucleotides of this invention can include genomic sequences, extra-genomic and plasmid-encoded sequences and smaller engineered gene segments that express, or may be adapted to express target antigens as described herein, fragments of antigens, peptides and the like. Such segments may be naturally isolated, or modified synthetically by the hand of man.

Polynucleotides may comprise a native sequence (i.e., an endogenous sequence that encodes a target antigen polypeptide/protein/epitope of the invention or a portion thereof) or may comprise a sequence that encodes a variant, fragment, or derivative of such a sequence. In certain embodiments, the polynucleotide sequences set forth herein encode target antigen proteins as described herein. In some embodiments, polynucleotides represent a novel gene sequence that has been optimized for expression in specific cell types (i.e. human cell lines) that may substantially vary from the native nucleotide sequence or variant but encode a similar protein antigen.

In other related embodiments, the present invention provides polynucleotide variants having substantial identity to native sequences encoding proteins (e.g., target antigens of interest) as described herein, for example those comprising at least 70% sequence identity, preferably at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% or higher, sequence identity compared to a native polynucleotide sequence encoding the polypeptides of this invention using the methods described herein, (e.g., BLAST analysis using standard parameters, as described below). One skilled in this art will recognize that these values can be appropriately adjusted to determine corresponding identity of proteins encoded by two nucleotide sequences by taking into account codon degeneracy, amino acid similarity, reading frame positioning and the like. In some embodiments, the present invention provides polynucleotides encoding a protein comprising for example at least 70% sequence identity, preferably at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, or 99% or higher, sequence identity compared to a protein sequence encoded by a native polynucleotide sequence of this invention using the methods described herein.

Typically, polynucleotide variants will contain one or more substitutions, additions, deletions and/or insertions, preferably such that the immunogenicity of the epitope of the polypeptide encoded by the variant polynucleotide or such that the immunogenicity of the heterologous target protein is not substantially diminished relative to a polypeptide encoded by the native polynucleotide sequence. In some cases, said one or more substitutions, additions, deletions and/or insertions may result in an increased immunogenicity of the epitope of the polypeptide encoded by the variant polynucleotide. As described elsewhere herein, the polynucleotide variants preferably encode a variant of the target antigen, or a fragment (e.g., an epitope) thereof wherein the propensity of the variant polypeptide or fragment (e.g., epitope) thereof to react with antigen-specific antisera and/or T-cell lines or clones is not substantially diminished, but optionally substantially increased, relative to the native polypeptide. The term “variants” should also be understood to encompass homologous genes of xenogenic origin. In particular embodiments, variants or fragments of target antigens are modified such that they have one or more reduced biological activities. For example, an oncogenic protein target antigen may be modified to reduce or eliminate the oncogenic activity of the protein, or a viral protein may be modified to reduce or eliminate one or more activities or the viral protein. An example of a modified CEA protein is a CEA having a N610D mutation, resulting in a variant protein with increased immunogenicity.

The present invention provides polynucleotides that comprise or consist of at least about 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95, 100, 11, 120, 130, 140, 150, 160, 170, 180, 190, 200, 210, 220, 230, 240, 250, 260, 270, 280, 290, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, or 1000 or more contiguous nucleotides encoding a polypeptide, including target protein antigens, as described herein, as well as all intermediate lengths there between. It will be readily understood that “intermediate lengths”, in this context, means any length between the quoted values, such as 16, 17, 18, 19, etc.; 21, 22, 23, etc.; 30, 31, 32, etc.; 50, 51, 52, 53, etc.; 100, 101, 102, 103, etc.; 150, 151, 152, 153, etc.; including all integers through 200-500; 500-1,000, and the like. A polynucleotide sequence as described herein may be extended at one or both ends by additional nucleotides not found in the native sequence encoding a polypeptide as described herein, such as an epitope or heterologous target protein. This additional sequence may consist of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 nucleotides or more, at either end of the disclosed sequence or at both ends of the disclosed sequence.

The polynucleotides of the present invention, or fragments thereof, regardless of the length of the coding sequence itself, may be combined with other DNA sequences, such as promoters, expression control sequences, polyadenylation signals, additional restriction enzyme sites, multiple cloning sites, other coding segments, and the like, such that their overall length may vary considerably. It is therefore contemplated that a nucleic acid fragment of almost any length may be employed, with the total length preferably being limited by the ease of preparation and use in the intended recombinant DNA protocol. For example, illustrative polynucleotide segments with total lengths of about 1000, 2000, 3000, 4000, 5000, 6000, 7000, 8000, 9000, 10,000, about 500, about 200, about 100, about 50 base pairs in length, and the like, (including all intermediate lengths) are contemplated to be useful in many implementations of this invention.

When comparing polynucleotide sequences, two sequences are said to be “identical” if the sequence of nucleotides in the two sequences is the same when aligned for maximum correspondence, as described below. Comparisons between two sequences are typically performed by comparing the sequences over a comparison window to identify and compare local regions of sequence similarity. A “comparison window” as used herein, refers to a segment of at least about 20 contiguous positions, usually 30 to about 75, 40 to about 50, in which a sequence may be compared to a reference sequence of the same number of contiguous positions after the two sequences are optimally aligned.

Optimal alignment of sequences for comparison may be conducted using the Megalign program in the Lasergene suite of bioinformatics software (DNASTAR, Inc., Madison, Wis.), using default parameters. This program embodies several alignment schemes described in the following references: Dayhoff, M. O. (1978) A model of evolutionary change in proteins—Matrices for detecting distant relationships. In Dayhoff, M. O. (ed.) Atlas of Protein Sequence and Structure, National Biomedical Research Foundation, Washington D.C. Vol. 5, Suppl. 3, pp. 345-358; Hein J., Unified Approach to Alignment and Phylogenes, pp. 626-645 (1990); Methods in Enzymology vol. 183, Academic Press, Inc., San Diego, Calif.; Higgins, D. G. and Sharp, P. M., CABIOS 5:151-153 (1989); Myers, E. W. and Muller W., CABIOS 4:11-17 (1988); Robinson, E. D., Comb. Theor 11:105 (1971); Saitou, N. Nei, M., Mol. Biol. Evol. 4:406-425 (1987); Sneath, P. H. A. and Sokal, R. R., Numerical Taxonomy—the Principles and Practice of Numerical Taxonomy, Freeman Press, San Francisco, Calif. (1973); Wilbur, W. J. and Lipman, D. J., Proc. Natl. Acad., Sci. USA 80:726-730 (1983).

Alternatively, optimal alignment of sequences for comparison may be conducted by the local identity algorithm of Smith and Waterman, Add. APL. Math 2:482 (1981), by the identity alignment algorithm of Needleman and Wunsch, J. Mol. Biol. 48:443 (1970), by the search for similarity methods of Pearson and Lipman, Proc. Natl. Acad. Sci. USA 85: 2444 (1988), by computerized implementations of these algorithms (GAP, BESTFIT, BLAST, FASTA, and TFASTA in the Wisconsin Genetics Software Package, Genetics Computer Group (GCG), 575 Science Dr., Madison, Wis.), or by inspection.

One example of algorithms that are suitable for determining percent sequence identity and sequence similarity are the BLAST and BLAST 2.0 algorithms, which are described in Altschul et al., Nucl. Acids Res. 25:3389-3402 (1977), and Altschul et al., J. Mol. Biol. 215:403-410 (1990), respectively. BLAST and BLAST 2.0 can be used, for example with the parameters described herein, to determine percent sequence identity for the polynucleotides of the invention. Software for performing BLAST analyses is publicly available through the National Center for Biotechnology Information. In one illustrative example, cumulative scores can be calculated using, for nucleotide sequences, the parameters M (reward score for a pair of matching residues; always >0) and N (penalty score for mismatching residues; always <0). Extension of the word hits in each direction are halted when: the cumulative alignment score falls off by the quantity X from its maximum achieved value; the cumulative score goes to zero or below, due to the accumulation of one or more negative-scoring residue alignments; or the end of either sequence is reached. The BLAST algorithm parameters W, T and X determine the sensitivity and speed of the alignment. The BLASTN program (for nucleotide sequences) uses as defaults a word length (W) of 11, and expectation (E) of 10, and the BLOSUM62 scoring matrix (see Henikoff and Henikoff, Proc. Natl. Acad. Sci. USA 89:10915 (1989)) alignments, (B) of 50, expectation (E) of 10, M=5, N=−4 and a comparison of both strands.

Preferably, the “percentage of sequence identity” is determined by comparing two optimally aligned sequences over a window of comparison of at least 20 positions, wherein the portion of the polynucleotide sequence in the comparison window may comprise additions or deletions (i.e., gaps) of 20 percent or less, usually 5 to 15 percent, or 10 to 12 percent, as compared to the reference sequences (which does not comprise additions or deletions) for optimal alignment of the two sequences. The percentage is calculated by determining the number of positions at which the identical nucleic acid bases occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the reference sequence (i.e., the window size) and multiplying the results by 100 to yield the percentage of sequence identity.

It will be appreciated by those of ordinary skill in the art that, as a result of the degeneracy of the genetic code, there are many nucleotide sequences that encode a particular antigen of interest, or fragment thereof, as described herein. Some of these polynucleotides bear minimal homology to the nucleotide sequence of any native gene. Nonetheless, polynucleotides that vary due to differences in codon usage are specifically contemplated by the present invention. Further, alleles of the genes comprising the polynucleotide sequences provided herein are within the scope of the present invention. Alleles are endogenous genes that are altered as a result of one or more mutations, such as deletions, additions and/or substitutions of nucleotides. The resulting mRNA and protein may, but need not, have an altered structure or function. Alleles may be identified using standard techniques (such as hybridization, amplification and/or database sequence comparison).

In another embodiment of the invention, a mutagenesis approach, such as site-specific mutagenesis, is employed for the preparation of variants and/or derivatives of the target antigen sequences, or fragments thereof, as described herein. By this approach, specific modifications in a polypeptide sequence can be made through mutagenesis of the underlying polynucleotides that encode them. These techniques provide a straightforward approach to prepare and test sequence variants, for example, incorporating one or more of the foregoing considerations, by introducing one or more nucleotide sequence changes into the polynucleotide.

Site-specific mutagenesis allows the production of mutants through the use of specific oligonucleotide sequences which encode the DNA sequence of the desired mutation, as well as a sufficient number of adjacent nucleotides, to provide a primer sequence of sufficient size and sequence complexity to form a stable duplex on both sides of the deletion junction being traversed. Mutations may be employed in a selected polynucleotide sequence to improve, alter, decrease, modify, or otherwise change the properties of the polynucleotide itself, and/or alter the properties, activity, composition, stability, or primary sequence of the encoded polypeptide.

In certain embodiments of the present invention, the inventors contemplate the mutagenesis of the disclosed polynucleotide sequences to alter one or more properties of the encoded polypeptide, such as the immunogenicity of an epitope comprised in a polypeptide or the oncogenicity of a target antigen. Assays to test the immunogenicity of a polypeptide or variant thereof are well known in the art and include, but are not limited to, T cell cytotoxicity assays (CTL/chromium release assays), T cell proliferation assays, intracellular cytokine staining, ELISA, ELISpot, etc. The techniques of site-specific mutagenesis are well known in the art, and are widely used to create variants of both polypeptides and polynucleotides. For example, site-specific mutagenesis is often used to alter a specific portion of a DNA molecule. In such embodiments, a primer comprising typically about 14 to about 25 nucleotides or so in length is employed, with about 5 to about 10 residues on both sides of the junction of the sequence being altered.

The preparation of sequence variants of the selected peptide-encoding DNA segments using site-directed mutagenesis provides a means of producing potentially useful species and is not meant to be limiting, as there are other ways in which sequence variants of peptides and the DNA sequences encoding them may be obtained. For example, recombinant vectors encoding the desired peptide sequence may be treated with mutagenic agents, such as hydroxylamine, to obtain sequence variants. Specific details regarding these methods and protocols are found in the teachings of Maloy et al., 1994; Segal, 1976; Prokop and Bajpai, 1991; Kuby, 1994; and Maniatis et al., 1982.

Polynucleotide segments or fragments encoding the polypeptides of the present invention may be readily prepared by, for example, directly synthesizing the fragment by chemical means, as is commonly practiced using an automated oligonucleotide synthesizer. Also, fragments may be obtained by application of nucleic acid reproduction technology, such as the PCR.technology of U.S. Pat. No. 4,683,202, by introducing selected sequences into recombinant vectors for recombinant production, and by other recombinant DNA techniques generally known to those of skill in the art of molecular biology (see for example, Current Protocols in Molecular Biology, John Wiley and Sons, NY, N.Y.).

In order to express a desired target antigen polypeptide or fragment or variant thereof, or fusion protein comprising any of the above, as described herein, the nucleotide sequences encoding the polypeptide, or functional equivalents, are inserted into an appropriate Ad as described elsewhere herein using recombinant techniques known in the art. The appropriate adenovirus vector may contain the necessary elements for the transcription and translation of the inserted coding sequence and any desired linkers. Methods which are well known to those skilled in the art may be used to construct these adenovirus vectors containing sequences encoding a polypeptide of interest and appropriate transcriptional and translational control elements. These methods include in vitro recombinant DNA techniques, synthetic techniques, and in vivo genetic recombination. Such techniques are described, for example, in Amalfitano et al., 1998 J. Virol. 72:926-933; Hodges, et al., 2000 J Gene Med 2:250-259; Sambrook, J. et al. (1989) Molecular Cloning, A Laboratory Manual, Cold Spring Harbor Press, Plainview, N. Y., and Ausubel, F. M. et al. (1989) Current Protocols in Molecular Biology, John Wiley & Sons, New York. N.Y.

A variety of vector/host systems may be utilized to contain and produce polynucleotide sequences. These include, but are not limited to, microorganisms such as bacteria transformed with recombinant bacteriophage, plasmid, or cosmid DNA vectors; yeast transformed with yeast vectors; insect cell systems infected with virus vectors (e.g., baculovirus); plant cell systems transformed with virus vectors (e.g., cauliflower mosaic virus, CaMV; tobacco mosaic virus, TMV) or with bacterial vectors (e.g., Ti or pBR322 plasmids); or animal cell systems.

The “control elements” or “regulatory sequences” present in an adenovirus vector may include those non-translated regions of the vector—enhancers, promoters, 5′ and 3′ untranslated regions—which interact with host cellular proteins to carry out transcription and translation. Such elements may vary in their strength and specificity. Depending on the vector system and host utilized, any number of suitable transcription and translation elements, including constitutive and inducible promoters, may be used. For example, sequences encoding a polypeptide of interest may be ligated into an Ad transcription/translation complex consisting of the late promoter and tripartite leader sequence. Insertion in a non-essential E1 or E3 region of the viral genome may be used to obtain a viable virus which is capable of expressing the polypeptide in infected host cells (Logan, J. and Shenk, T. (1984) Proc. Natl. Acad. Sci. 81:3655-3659). In addition, transcription enhancers, such as the Rous sarcoma virus (RSV) enhancer, may be used to increase expression in mammalian host cells.

Specific initiation signals may also be used to achieve more efficient translation of sequences encoding a polypeptide of interest. Such signals include the ATG initiation codon and adjacent sequences. In cases where sequences encoding the polypeptide, its initiation codon, and upstream sequences are inserted into the appropriate expression vector, no additional transcriptional or translational control signals may be needed. However, in cases where only coding sequence, or a portion thereof, is inserted, exogenous translational control signals including the ATG initiation codon can be provided. Furthermore, the initiation codon should be in the correct reading frame to ensure translation of the entire insert. Exogenous translational elements and initiation codons may be of various origins, both natural and synthetic. The efficiency of expression may be enhanced by the inclusion of enhancers which are appropriate for the particular cell system which is used, such as those described in the literature (Scharf, D. et al. (1994) Results Probl. Cell Differ. 20:125-162). Specific termination sequences, either for transcription or translation, may also be incorporated in order to achieve efficient translation of the sequence encoding the polypeptide of choice.

A variety of protocols for detecting and measuring the expression of polynucleotide-encoded products (e.g., target antigens of interest), using either polyclonal or monoclonal antibodies specific for the product are known in the art. Examples include enzyme-linked immunosorbent assay (ELISA), radioimmunoassay (RIA), and fluorescence activated cell sorting (FACS). A two-site, monoclonal-based immunoassay utilizing monoclonal antibodies reactive to two non-interfering epitopes on a given polypeptide may be preferred for some applications, but a competitive binding assay may also be employed. These and other assays are described, among other places, in Hampton, R. et al. (1990; Serological Methods, a Laboratory Manual, APS Press, St Paul. Minn.) and Maddox, D. E. et al. (1983; J. Exp. Med. 158:1211-1216).

The adenovirus vectors of the present invention comprise nucleic acid sequences encoding one or more antigens of interest, or variants or fragments thereof. The nucleic acid sequence may also contain a product that can be detected or selected for. As referred to herein, a “reporter” gene is one whose product can be detected, such as by fluorescence, enzyme activity on a chromogenic or fluorescent substrate, and the like or selected for by growth conditions.

Such reporter genes include, without limitation, green fluorescent protein (GFP), β-galactosidase, chloramphenicol acetyltransferase (CAT), luciferase, neomycin phosphotransferase, secreted alkaline phosphatase (SEAP), and human growth hormone (HGH). Selectable markers include drug resistances, such as neomycin (G418), hygromycin, and the like.

The nucleic acid encoding an antigen of interest may also comprise a promoter or expression control sequence. This is a nucleic acid sequence that controls expression of the nucleic acid sequence encoding a target antigen and generally is active or activatable in the targeted cell. The choice of the promoter will depend in part upon the targeted cell type and the degree or type of control desired. Promoters that are suitable within the context of the present invention include, without limitation, constitutive, inducible, tissue specific, cell type specific, temporal specific, or event-specific.

Examples of constitutive or nonspecific promoters include the SV40 early promoter (U.S. Pat. No. 5,118,627), the SV40 late promoter (U.S. Pat. No. 5,118,627), CMV early gene promoter (U.S. Pat. No. 5,168,062), bovine papilloma virus promoter, and adenovirus promoter. In addition to viral promoters, cellular promoters are also amenable within the context of this invention. In particular, cellular promoters for the so-called housekeeping genes are useful (e.g., β-actin). Viral promoters are generally stronger promoters than cellular promoters.

Inducible promoters may also be used. These promoters include MMTV LTR (PCT WO 91/13160), inducible by dexamethasone, metallothionein, inducible by heavy metals, and promoters with cAMP response elements, inducible by cAMP, heat shock, promoter. By using an inducible promoter, the nucleic acid may be delivered to a cell and will remain quiescent until the addition of the inducer. This allows further control on the timing of production of the protein of interest.

Event-type specific promoters are active or upregulated only upon the occurrence of an event, such as tumorigenicity or viral infection, for example. The HIV LTR is a well-known example of an event-specific promoter. The promoter is inactive unless the tat gene product is present, which occurs upon viral infection. Some event-type promoters are also tissue-specific. Preferred event-type specific promoters include promoters activated upon viral infection.

Examples of promoters discussed herein include, but are not limited to, promoters for alphafetoprotein, alpha actin, myo D, carcinoembryonic antigen, VEGF-receptor (GenBank Accession No. X89776); FGF receptor; TEK or tie 2 (GenBank Accession No. L06139); tie (GenBank Accession Nos. X60954; S89716); urokinase receptor (GenBank Accession No. S78532); E- and P-selectins (GenBank Accession Nos. M64485; L01874); VCAM-1 (GenBank Accession No. M92431); endoglin (GenBank Accession No. HSENDOG); endosialin (Rettig et al., PNAS 89:10832, 1992); alpha V-beta3 integrin (Villa-Garcia et al., Blood 3:668, 1994; Donahue et al., BBA 1219:228, 1994); endothelin-1 (GenBank Accession Nos. M25377; J04819; J05489); ICAM-3 (GenBank Accession No. S50015); E9 antigen (Wang et al., Int. J. Cancer 54:363, 1993); von Willebrand factor (GenBank Accession Nos. HUMVWFI; HUMVWFA); CD44 (GenBank Accession No. HUMCD44B); CD40 (GenBank Accession Nos. HACD40L; HSCD405FR); vascular-endothelial cadherin (Martin-Padura et al., J. Pathol. 175:51, 1995); notch 4 (Uyttendaele et al., Development 122:2251, 1996) high molecular weight melanoma-associated antigen; prostate specific antigen-1, probasin, FGF receptor, VEGF receptor, erb B2; erb B3; erb B4; MUC-1; HSP-27; int-1; int-2, CEA, HBEGF receptor; EGF receptor; tyrosinase, MAGE, IL-2 receptor; prostatic acid phosphatase, probasin, prostate specific membrane antigen, alpha-crystallin, PDGF receptor, integrin receptor, α-actin, SM1 and SM2 myosin heavy chains, calponin-hl, SM22 alpha angiotensin receptor, IL-1, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-11, IL-12, IL-13, IL-14, immunoglobulin heavy chain, immunoglobulin light chain, CD4, and the like are useful within the context of this invention.

In addition to the promoter, repressor sequences, negative regulators, or tissue-specific silencers may be inserted to reduce non-specific expression of the polynucleotide. Multiple repressor elements may be inserted in the promoter region. Repression of transcription is independent of the orientation of repressor elements or distance from the promoter. One type of repressor sequence is an insulator sequence. Such sequences inhibit transcription (Dunaway et al., Mol Cell Biol 17: 182-9, 1997; Gdula et al., Proc Natl Acad Sci USA 93:9378-83, 1996, Chan et al., J Virol 70: 5312-28, 1996; Scott and Geyer, EMBO J. 14: 6258-67, 1995; Kalos and Fournier, Mol Cell Biol 15: 198-207, 1995; Chung et al., Cell 74: 505-14, 1993) and can silence background transcription.

Negative regulatory elements can be located in the promoter regions of a number of different genes. The repressor element can function as a repressor of transcription in the absence of factors, such as steroids, as does the NSE in the promoter region of the ovalbumin gene (Haecker et al., Mol. Endocrinology. 9:1113-1126, 1995). These negative regulatory elements can bind specific protein complexes from oviduct, none of which are sensitive to steroids. Three different elements are located in the promoter of the ovalbumin gene. Oligonucleotides corresponding to portions of these elements can repress viral transcription of the TK reporter. One of the silencer elements shares sequence identity with silencers in other genes (TCTCTCCNA (SEQ ID NO: 6)).

Further, repressor elements can be located in the promoter region of a variety of genes, including the collagen II gene, for example. Nuclear factors from HeLa cells can bind specifically to DNA fragments containing the silencer region (Savanger et al., J. Biol. Chem. 265(12):6669-6674, 1990). Repressor elements may play a role regulating transcription in the carbamyl phosphate synthetase gene (Goping et al., Nucleic Acid Research 23(10):1717-1721, 1995). This gene is expressed in only two different cell types, hepatocytes and epithelial cells of the intestinal mucosa. Negative regulatory regions are also found in the promoter region of the choline acetyltransferase gene, the albumin promoter (Hu et al., J. Cell Growth Differ. 3(9):577-588, 1992), phosphoglycerate kinase (PGK-2) gene promoter (Misuno et al., Gene 119(2):293-297, 1992), and in the 6-phosphofructo-2-kinase/fructose-2, 6-bisphosphatase gene, in which the negative regulatory element inhibits transcription in non-hepatic cell lines (Lemaigre et al., Mol. Cell. Biol. 11(2):1099-1106). Furthermore, the negative regulatory element Tse-1 is located in a number of liver specific genes, including tyrosine aminotransferase (TAT). TAT gene expression is liver specific and inducible by both glucocorticoids and the cAMP signaling pathway. The cAMP response element (CRE) can ask as the target for repression by Tse-1 and hepatocyte-specific elements (Boshart et al., Cell 61(5):905-916, 1990). Accordingly, it is clear that varieties of such elements are known or are readily identified.

In certain embodiments, elements that increase the expression of the desired target antigen are incorporated into the nucleic acid sequence of the adenovirus vectors described herein. Such elements include, but are not limited to internal ribosome binding sites (IRES; Wang and Siddiqui, Curr. Top. Microbiol. Immunol 203:99, 1995; Ehrenfeld and Semler, Curr. Top. Microbiol. Immunol. 203:65, 1995; Rees et al., Biotechniques 20:102, 1996; Sugimoto et al., Biotechnology 12:694, 1994). IRES can increase translation efficiency. As well, other sequences may enhance expression. For some genes, sequences especially at the 5′ end may inhibit transcription and/or translation. These sequences are usually palindromes that can form hairpin structures. In some cases, such sequences in the nucleic acid to be delivered are deleted. Expression levels of the transcript or translated product can be assayed to confirm or ascertain which sequences affect expression. Transcript levels may be assayed by any known method, including Northern blot hybridization, RNase probe protection and the like. Protein levels may be assayed by any known method, including ELISA.

As would be recognized by the skilled artisan, the adenovirus vectors of the present invention comprising heterologous nucleic acid sequences can be generated using recombinant techniques known in the art, such as those described in Maione et al., 2001 Proc Natl Acad Sci USA, 98:5986-5991; Maione et al., 2000 Hum Gene Ther 11:859-868; Sandig et al. 2000 Proc Natl Acad Sci USA, 97:1002-1007; Harui et al. 2004 Gene Therapy, 11:1617-1626; Parks et al., 1996 Proc Natl Acad Sci USA, 93:13565-13570; DelloRusso et al., 2002 Proc Natl Acad Sci USA, 99:12979-12984; Current Protocols in Molecular Biology, John Wiley and Sons, NY, N.Y.).

As noted above, the adenovirus vectors of the present invention comprise nucleic acid sequences that encode one or more target proteins or antigens of interest. In this regard, the vectors may contain nucleic acid encoding 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more different target antigens of interest. The target antigens may be a full length protein or may be a fragment (e.g., an epitope) thereof. The adenovirus vectors may contain nucleic acid sequences encoding multiple fragments or epitopes from one target protein of interest or may contain one or more fragments or epitopes from numerous different target proteins of interest. In some embodiments, the target antigen or protein comprises CEA.

The term “target antigen” or “target protein” as used herein refers to a molecule, such as a protein, against which an immune response is to be directed. The target antigen may comprise any substance against which it is desirable to generate an immune response but generally, the target antigen is a protein. A target antigen may comprise a full length protein or a fragment thereof that induces an immune response (i.e., an immunogenic fragment). A target antigen or fragment thereof may be modified, e.g., to reduce one or more biological activities of the target antigen or to enhance its immunogenicity. In some embodiments, the target antigen or target protein is CEA.

An “immunogenic fragment”, as used herein is a fragment of a polypeptide that is specifically recognized (i.e., specifically bound) by a B-cell and/or T-cell surface antigen receptor resulting in the generation of an immune response specifically against the fragment. In certain embodiments, immunogenic fragments bind to an MHC class I or class II molecule. As used herein, an immunogenic fragment is said to “bind to” an MHC class I or class II molecule if such binding is detectable using any assay known in the art. For example, the ability of a polypeptide to bind to MHC class I may be evaluated indirectly by monitoring the ability to promote incorporation of ¹²⁵I labeled β.2-microglobulin (β 2 m) into MHC class I/β2 m/peptide heterotrimeric complexes (see Parker et al., J. Immunol. 152:163, 1994). Alternatively, functional peptide competition assays that are known in the art may be employed. Immunogenic fragments of polypeptides may generally be identified using well known techniques, such as those summarized in Paul, Fundamental Immunology, 3rd ed., 243-247 (Raven Press, 1993) and references cited therein. Representative techniques for identifying immunogenic fragments include screening polypeptides for the ability to react with antigen-specific antisera and/or T-cell lines or clones. An immunogenic fragment of a particular target polypeptide is a fragment that reacts with such antisera and/or T-cells at a level that is not substantially less than the reactivity of the full length target polypeptide (e.g., in an ELISA and/or T-cell reactivity assay). In other words, an immunogenic fragment may react within such assays at a level that is similar to or greater than the reactivity of the full length polypeptide. Such screens may generally be performed using methods well known to those of ordinary skill in the art, such as those described in Harlow and Lane, Antibodies: A Laboratory Manual, Cold Spring Harbor Laboratory, 1988.

Target antigens of the present invention include but are not limited to antigens derived from any of a variety of infectious agents or cancer cells. An infectious agent may refer to any living organism capable of infecting a host. Cancer typically includes a neoplastic cell. Infectious agents include, for example, bacteria, any variety of viruses, such as, single stranded RNA viruses, single stranded DNA viruses, fungi, parasites, and protozoa. Examples of infectious agents include, but are not limited to, Actinobacillus spp., Actinomyces spp., Adenovirus (types 1, 2, 3, 4, 5 et 7), Adenovirus (types 40 and 41), Aerococcus spp., Aeromonas hydrophila, Ancylostoma duodenale, Angiostrongylus cantonensis, Ascaris lumbricoides, Ascaris spp., Aspergillus spp., Babesia spp, B. microti, Bacillus anthracis, Bacillus cereus, Bacteroides spp., Balantidium coli, Bartonella bacilliformis, Blastomyces dermatitidis, Bluetongue virus, Bordetella bronchiseptica, Bordetella pertussis, Borrelia afzelii, Borrelia burgdorferi, Borrelia garinii, Branhamella catarrhalis, Brucella spp. (B. abortus, B. canis, B. melitensis, B. suis), Brugia spp., Burkholderia, (Pseudomonas) mallei, Burkholderia (Pseudomonas) pseudomallei, California serogroup, Campylobacter fetus subsp. Fetus, Campylobacter jejuni, C. coli, C. fetus subsp. Jejuni, Candida albicans, Capnocytophaga spp., Chikungunya virus, Chlamydia psittaci, Chlamydia trachomatis, Citrobacter spp., Clonorchis sinensis, Clostridium botulinum, Clostridium difficile, Clostridium perfringens, Clostridium tetani, Clostridium spp. (with the exception of those species listed above), Coccidioides immitis, Colorado tick fever virus, Corynebacterium diphtheriae, Coxiella burnetii, Coxsackievirus, Creutzfeldt-Jakob agent, Kuru agent, Crimean-Congo hemorrhagic fever virus, Cryptococcus neoformans, Cryptosporidium parvum, Cytomegalovirus, Cyclospora cayatanesis, Dengue virus (1, 2, 3, 4), Diphtheroids, Eastern (Western) equine encephalitis virus, Ebola virus, Echinococcus granulosus, Echinococcus multilocularis, Echovirus, Edwardsiella tarda, Entamoeba histolytica, Enterobacter spp., Enterovirus 70, Epidermophyton floccosum, Ehrlichia spp, Ehrlichia sennetsu, Microsporum spp. Trichophyton spp., Epstein-Barr virus, Escherichia coli, enterohemorrhagic, Escherichia coli, enteroinvasive, Escherichia coli, enteropathogenic, Escherichia coli, enterotoxigenic, Fasciola hepatica, Francisella tularensis, Fusobacterium spp., Gemella haemolysans, Giardia lamblia, Guanarito virus, Haemophilus ducreyi, Haemophilus influenzae (group b), Hantavirus, Hepatitis A virus, Hepatitis B virus, Hepatitis C virus, Hepatitis D virus, Hepatitis E virus, Herpes simplex virus, Herpesvirus simiae, Histoplasma capsulatum, Human coronavirus, Human immunodeficiency virus, Human papillomavirus, Human rotavirus, Human T-lymphotrophic virus, Influenza virus including H5N1, Junin virus/Machupo virus, Klebsiella spp., Kyasanur Forest disease virus, Lactobacillus spp., Lassa virus, Legionella pneumophila, Leishmania major, Leishmania infantum, Leishmania spp., Leptospira interrogans, Listeria monocytogenes, Lymphocytic choriomeningitis virus, Machupo virus, Marburg virus, Measles virus, Micrococcus spp., Moraxella spp., Mycobacterium spp. (other than M. bovis, M. tuberculosis, M. avium, M. leprae), Mycobacterium tuberculosis, M. bovis, Mycoplasma hominis, M. orale, M. salivarium, M. fermentans, Mycoplasma pneumoniae, Naegleria fowleri, Necator americanus, Neisseria gonorrhoeae, Neisseria meningitides, Neisseria spp. (other than N. gonorrhoeae and N. meningitidis), Nocardia spp., Norwalk virus, Omsk hemorrhagic fever virus, Onchocerca volvulus, Opisthorchis spp., Parvovirus B19, Pasteurella spp., Peptococcus spp., Peptostreptococcus spp., Plasmodium falciparum, Plasmodium vivax, Plasmodium spp., Plesiomonas shigelloides, Powassan encephalitis virus, Proteus spp., Pseudomonas spp. (other than P. mallei, P. pseudomallei), Rabies virus, Respiratory syncytial virus, Rhinovirus, Rickettsia akari, Rickettsia prowazekii, R. Canada, Rickettsia rickettsii, Rift Valley virus, Ross river virus/O'Nyong-Nyong virus, Rubella virus, Salmonella choleraesuis, Salmonella paratyphi, Salmonella typhi, Salmonella spp. (with the exception of those species listed above), Schistosoma spp., Scrapie agent, Serratia spp., Shigella spp., Sindbis virus, Sporothrix schenckii, St. Louis encephalitis virus, Murray Valley encephalitis virus, Staphylococcus aureus, Streptobacillus moniliformis, Streptococcus agalactiae, Streptococcus faecalis, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus salivarius, Taenia saginata, Taenia solium, Toxocara canis, T. cati, T. cruzi, Toxoplasma gondii, Treponema pallidum, Trichinella spp., Trichomonas vaginalis, Trichuris trichiura, Trypanosoma brucei, Trypanosoma cruzi, Ureaplasma urealyticum, Vaccinia virus, Varicella-zoster virus, eastern equine encephalitis virus (EEEV), severe acute respiratory virus (SARS), Venezuelan equine encephalitis virus (VEEV), Vesicular stomatitis virus, Vibrio cholerae, serovar 01, Vibrio parahaemolyticus, West Nile virus, Wuchereria bancrofti, Yellow fever virus, Yersinia enterocolitica, Yersinia pseudotuberculosis, and Yersinia pestis.

Examples of infectious agents associated with human malignancies include Epstein-Barr virus, Helicobacter pylori, Hepatitis B virus, Hepatitis C virus, Human heresvirus-8, Human immunodeficiency virus, Human papillomavirus, Human T cell leukemia virus, liver flukes, and Schistosoma haematobium.

A number of viruses are associated with viral hemorrhagic fever, including filoviruses (e.g., Ebola, Marburg, and Reston), arenaviruses (e.g. Lassa, Junin, and Machupo), and bunyaviruses. In addition, phleboviruses, including, for example, Rift Valley fever virus, have been identified as etiologic agents of viral hemorrhagic fever. Etiological agents of hemorrhagic fever and associated inflammation may also include paramyxoviruses, particularly respiratory syncytial virus (Feldmann, H. et al. (1993) Arch Virol Suppl. 7:81-100). In addition, other viruses causing hemorrhagic fevers in man have been identified as belonging to the following virus groups: togavirus (Chikungunya), flavivirus (dengue, yellow fever, Kyasanur Forest disease, Omsk hemorrhagic fever), nairovirus (Crimian-Congo hemorrhagic fever) and hantavirus (hemorrhagic fever with renal syndrome, nephropathic epidemia). Furthermore, Sin Nombre virus was identified as the etiologic agent of the 1993 outbreak of hantavirus pulmonary syndrome in the American Southwest.

Target antigens may include proteins, or variants or fragments thereof, produced by any of the infectious organisms described herein, such as, but not limited to, viral coat proteins, i.e., influenza neuraminidase and hemagglutinin, HIV gp160 or derivatives thereof, HIV Gag, HIV Nef, HIV Pol, SARS coat proteins, herpes virion proteins, WNV proteins, etc. Target antigens may also include bacterial surface proteins including pneumococcal PsaA, PspA, LytA, surface or virulence associated proteins of bacterial pathogens such as Nisseria gonnorhea, outer membrane proteins or surface proteases.

Target antigens may also include proteins, or variants or fragments thereof, of infectious agents associated with human malignancies such as the human papillomavirus (HPV) oncoproteins E6 and E7. In certain embodiments, the oncoprotein may be modified to produce a non-oncogenic variant or a variant having reduced oncogenicity relative to the wild type protein. For example, the portion of the peptide that is responsible for binding a tumor suppressor protein (e.g., p53 and pRb) may be deleted or modified so that it no longer interacts with the tumor suppressor protein. As another example, an oncoprotein that is a kinase, such as Her2/neu, may be kinase-inactivated, e.g., by point mutation. In some instances, two or more target antigens may be used during immunization. For example, the E6 and E7 antigens can be combined in a fusion protein, or separate vectors containing heterologous nucleotides encoding the modified or unmodified E6 and E7 target antigens are used in combination. For example, an Ad5-E6 vector can be administered with an Ad5-E7 vector. In this example, the Ad5-E6 vector and Ad5-E7 vector may be administered simultaneously or they may be administered sequentially.

Target antigens of the present invention include but are not limited to antigens derived from a variety of tumor proteins. Illustrative tumor proteins useful in the present invention include, but are not limited to any one or more of, WT1, HPV E6, HPV E7, p53, MAGE-A1, MAGE-A2, MAGE-A3, MAGE-A4, MAGE-A6, MAGE-A10, MAGE-A12, BAGE, DAM-6, -10, GAGE-1, -2, -8, GAGE-3, -4, -5, -6, -7B, NA88-A, NY-ESO-1, MART-1, MC1R, Gp100, PSA, PSM, Tyrosinase, TRP-1, TRP-2, ART-4, CAMEL, CEA, Cyp-B, Her2/neu, BRCA1, hTERT, hTRT, iCE, MUC1, MUC2, PRAME, P15, RU1, RU2, SART-1, SART-3, WT1, AFP, β-catenin/m, Caspase-8/m, CEA, CDK-4/m, ELF2M, GnT-V, G250, HSP70-2M, HST-2, KIAA0205, MUM-1, MUM-2, MUM-3, Myosin/m, RAGE, SART-2, TRP-2/INT2, 707-AP, Annexin II, CDC27/m, TPI/mbcr-abl, ETV6/AML, LDLR/FUT, Pml/RARα, and TEL/AML1. These and other tumor proteins are known to the skilled artisan. In some embodiments, parts or variants of tumor proteins are employed as target antigens. In some embodiments, parts or variants of tumor proteins being employed as target antigens have a modified, for example, increased ability to effect and immune response against the tumor protein or cells containing the same.

In some embodiments, a replication defective adenovirus vector, e.g. the vector identified by SEQ. ID. NO.: 3, comprises a sequence encoding a target antigen described herein, or a fragment, a variant, or a variant fragment thereof, at a suitable position on the sequence, for example at a position replacing the nucleic acid sequence encoding a CEA or a variant CEA, e.g. the sequence identified by SEQ. ID. NO.: 1.

In certain embodiments tumor antigens may be identified directly from an individual with cancer. In this regard, screens can be carried out using a variety of known technologies. For example, in one embodiment, a tumor biopsy is taken from a patient, RNA is isolated from the tumor cells and screened using a gene chip (for example, from Affymetrix, Santa Clara, Calif.) and a tumor antigen is identified. Once the tumor target antigen is identified, it may then be cloned, expressed and purified using techniques known in the art. This target molecule is then linked to one or more epitopes/cassettes of the present invention as described herein and administered to the cancer patient in order to alter the immune response to the target molecule isolated from the tumor. In this manner, “personalized vaccines” are contemplated within the context of the invention. In certain embodiments, cancers may include carcinomas or sarcomas. In some embodiments, a personalized tumor antigen related to CEA is characterized from a patient and further utilized as the target antigen as a whole, in part or as a variant.

The adenovirus vectors of the present invention may also include nucleic acid sequences that encode proteins that increase the immunogenicity of the target antigen. In this regard, the protein produced following immunization with the adenovirus vector containing such a protein may be a fusion protein comprising the target antigen of interest fused to a protein that increases the immunogenicity of the target antigen of interest.

In one embodiment, such an “immunological fusion partner” is derived from a Mycobacterium sp., such as a Mycobacterium tuberculosis-derived Ra12 fragment. Ra12 compositions and methods for their use in enhancing the expression and/or immunogenicity of heterologous polynucleotide/polypeptide sequences are described in U.S. Patent Application 60/158,585 and U.S. Pat. No. 7,009,042, which are herein incorporated by reference in their entirety. Briefly, Ra12 refers to a polynucleotide region that is a subsequence of a Mycobacterium tuberculosis MTB32A nucleic acid. MTB32A is a serine protease of 32 KD molecular weight encoded by a gene in virulent and avirulent strains of M. tuberculosis. The nucleotide sequence and amino acid sequence of MTB32A have been described (for example, U.S. Patent Application 60/158,585; see also, Skeiky et al., Infection and Immun. 67:3998-4007 (1999), incorporated herein by reference in their entirety). C-terminal fragments of the MTB32A coding sequence express at high levels and remain as soluble polypeptides throughout the purification process. Moreover, Ra12 may enhance the immunogenicity of heterologous immunogenic polypeptides with which it is fused. One Ra12 fusion polypeptide comprises a 14 KD C-terminal fragment corresponding to amino acid residues 192 to 323 of MTB32A. Other Ra12 polynucleotides generally comprise at least about 15 consecutive nucleotides, at least about 30 nucleotides, at least about 60 nucleotides, at least about 100 nucleotides, at least about 200 nucleotides, or at least about 300 nucleotides that encode a portion of a Ra12 polypeptide. Ra12 polynucleotides may comprise a native sequence (i.e., an endogenous sequence that encodes a Ra12 polypeptide or a portion thereof) or may comprise a variant of such a sequence. Ra12 polynucleotide variants may contain one or more substitutions, additions, deletions and/or insertions such that the biological activity of the encoded fusion polypeptide is not substantially diminished, relative to a fusion polypeptide comprising a native Ra12 polypeptide. Variants preferably exhibit at least about 70% identity, more preferably at least about 80% identity and most preferably at least about 90% identity to a polynucleotide sequence that encodes a native Ra12 polypeptide or a portion thereof.

Within another embodiment, an immunological fusion partner is derived from protein D, a surface protein of the gram-negative bacterium Haemophilus influenza B (WO 91/18926). In some cases, a protein D derivative comprises approximately the first third of the protein (e.g., the first N-terminal 100-110 amino acids). A protein D derivative may be lipidated. Within certain embodiments, the first 109 residues of a Lipoprotein D fusion partner is included on the N-terminus to provide the polypeptide with additional exogenous T-cell epitopes, which may increase the expression level in E. coli and may function as an expression enhancer. The lipid tail may ensure optimal presentation of the antigen to antigen presenting cells. Other fusion partners include the non-structural protein from influenzae virus, NS 1 (hemagglutinin) Typically, the N-terminal 81 amino acids are used, although different fragments that include T-helper epitopes may be used.

In another embodiment, the immunological fusion partner is the protein known as LYTA, or a portion thereof (preferably a C-terminal portion). LYTA is derived from Streptococcus pneumoniae, which synthesizes an N-acetyl-L-alanine amidase known as amidase LYTA (encoded by the LytA gene; Gene 43:265-292, 1986). LYTA is an autolysin that specifically degrades certain bonds in the peptidoglycan backbone. The C-terminal domain of the LYTA protein is responsible for the affinity to the choline or to some choline analogues such as DEAE. This property has been exploited for the development of E. coli C-LYTA expressing plasmids useful for expression of fusion proteins. Purification of hybrid proteins containing the C-LYTA fragment at the amino terminus has been described (see Biotechnology 10:795-798, 1992). Within another embodiment, a repeat portion of LYTA may be incorporated into a fusion polypeptide. A repeat portion can, for example, be found in the C-terminal region starting at residue 178. One particular repeat portion incorporates residues 188-305.

Methods of Use

The adenovirus vectors of the present invention can be used in a number of vaccine settings for generating an immune response against one or more target antigens as described herein. The adenovirus vectors are of particular importance because of the unexpected finding that they can be used to generate immune responses in subjects who have preexisting immunity to Ad and can be used in vaccination regimens that include multiple rounds of immunization using the adenovirus vectors, regimens not possible using previous generation adenovirus vectors.

Generally, generating an immune response comprises an induction of a humoral response and/or a cell-mediated response. In certain embodiments, it is desirable to increase an immune response against a target antigen of interest. In certain circumstances, generating an immune response may involve a decrease in the activity and/or number of certain cells of the immune system or a decrease in the level and/or activity of certain cytokines or other effector molecules. As such “generating an immune response” or “inducing an immune response” comprises any statistically significant change, e.g. increase or decrease, in the number of one or more immune cells (T cells, B cells, antigen-presenting cells, dendritic cells, neutrophils, and the like) or in the activity of one or more of these immune cells (CTL activity, HTL activity, cytokine secretion, change in profile of cytokine secretion, etc.).

The skilled artisan would readily appreciate that a number of methods for establishing whether an alteration in the immune response has taken place are available. A variety of methods for detecting alterations in an immune response (e.g. cell numbers, cytokine expression, cell activity) are known in the art and are useful in the context of the instant invention. Illustrative methods are described in Current Protocols in Immunology, Edited by: John E. Coligan, Ada M. Kruisbeek, David H. Margulies, Ethan M. Shevach, Warren Strober (2001 John Wiley & Sons, NY, N.Y.) Ausubel et al. (2001 Current Protocols in Molecular Biology, Greene Publ. Assoc. Inc. & John Wiley & Sons, Inc., NY, N.Y.); Sambrook et al. (1989 Molecular Cloning, Second Ed., Cold Spring Harbor Laboratory, Plainview, N.Y.); Maniatis et al. (1982 Molecular Cloning, Cold Spring Harbor Laboratory, Plainview, N.Y.) and elsewhere. Illustrative methods useful in this context include intracellular cytokine staining (ICS), ELISpot, proliferation assays, cytotoxic T cell assays including chromium release or equivalent assays, and gene expression analysis using any number of polymerase chain reaction (PCR) or RT-PCR based assays.

In certain embodiments, generating an immune response comprises an increase in target antigen-specific CTL activity of between 1.5 and 5 fold in a subject administered the adenovirus vectors of the invention as compared to a control. In another embodiment, generating an immune response comprises an increase in target-specific CTL activity of about 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 15, 16, 17, 18, 19, 20, or more fold in a subject administered the adenovirus vectors as compared to a control.

In a further embodiment, generating an immune response comprises an increase in target antigen-specific HTL activity, such as proliferation of helper T cells, of between 1.5 and 5 fold in a subject administered the adenovirus vectors of the invention that comprise nucleic acid encoding the target antigen as compared to an appropriate control. In another embodiment, generating an immune response comprises an increase in target-specific HTL activity of about 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 15, 16, 17, 18, 19, 20, or more fold as compared to a control. In this context, HTL activity may comprise an increase as described above, or decrease, in production of a particular cytokine, such as interferon-gamma (IFN-γ), interleukin-1 (IL-1), IL-2, IL-3, IL-6, IL-7, IL-12, IL-15, tumor necrosis factor-alpha (TNF-α), granulocyte macrophage colony-stimulating factor (GM-CSF), granulocyte-colony stimulating factor (G-CSF), or other cytokine. In this regard, generating an immune response may comprise a shift from a Th2 type response to a Th1 type response or in certain embodiments a shift from a Th1 type response to a Th2 type response. In other embodiments, generating an immune response may comprise the stimulation of a predominantly Th1 or a Th2 type response.

In a further embodiment, generating an immune response comprises an increase in target-specific antibody production of between 1.5 and 5 fold in a subject administered the adenovirus vectors of the present invention as compared to an appropriate control. In another embodiment, generating an immune response comprises an increase in target-specific antibody production of about 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 10.5, 11, 11.5, 12, 12.5, 15, 16, 17, 18, 19, 20, or more fold in a subject administered the adenovirus vector as compared to a control.

Thus the present invention provides methods for generating an immune response against a target antigen of interest comprising administering to the individual an adenovirus vector comprising: a) a replication defective adenovirus vector, wherein the adenovirus vector has a deletion in the E2b region, and b) a nucleic acid encoding the target antigen; and readministering the adenovirus vector at least once to the individual; thereby generating an immune response against the target antigen. In certain embodiments, the present invention provides methods wherein the vector administered is not a gutted vector. In particular embodiments, the target antigen may be a wild-type protein, a fragment, a variant, or a variant fragment thereof. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

In a further embodiment, the present invention provides methods for generating an immune response against a target antigen in an individual, wherein the individual has preexisting immunity to Ad, by administering to the individual an adenovirus vector comprising: a) a replication defective adenovirus vector, wherein the adenovirus vector has a deletion in the E2b region, and b) a nucleic acid encoding the target antigen; and readministering the adenovirus vector at least once to the individual; thereby generating an immune response against the target antigen. In particular embodiments, the target antigen may be a wild-type protein, a fragment, a variant, or a variant fragment thereof. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

With regard to preexisting immunity to Ad, this can be determined using methods known in the art, such as antibody-based assays to test for the presence of Ad antibodies. Further, in certain embodiments, the methods of the present invention include first determining that an individual has preexisting immunity to Ad then administering the E2b deleted adenovirus vectors of the invention as described herein.

One embodiment of the invention provides a method of generating an immune response against one or more target antigens in an individual comprising administering to the individual a first adenovirus vector comprising a replication defective adenovirus vector, wherein the adenovirus vector has a deletion in the E2b region, and a nucleic acid encoding at least one target antigen; administering to the individual a second adenovirus vector comprising a replication defective adenovirus vector, wherein the adenovirus vector has a deletion in the E2b region, and a nucleic acid encoding at least one target antigen, wherein the at least one target antigen of the second adenovirus vector is the same or different from the at least one target antigen of the first adenovirus vector. In particular embodiments, the target antigen may be a wild-type protein, a fragment, a variant, or a variant fragment thereof. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

Thus, the present invention contemplates multiple immunizations with the same E2b deleted adenovirus vector or multiple immunizations with different E2b deleted adenovirus vectors. In each case, the adenovirus vectors may comprise nucleic acid sequences that encode one or more target antigens as described elsewhere herein. In certain embodiments, the methods comprise multiple immunizations with an E2b deleted adenovirus encoding one target antigen, and re-administration of the same adenovirus vector multiple times, thereby inducing an immune response against the target antigen. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

In a further embodiment, the methods comprise immunization with a first adenovirus vector that encodes one or more target antigens, and then administration with a second adenovirus vector that encodes one or more target antigens that may be the same or different from those antigens encoded by the first adenovirus vector. In this regard, one of the encoded target antigens may be different or all of the encoded antigens may be different, or some may be the same and some may be different. Further, in certain embodiments, the methods include administering the first adenovirus vector multiple times and administering the second adenovirus multiple times. In this regard, the methods comprise administering the first adenovirus vector 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or more times and administering the second adenovirus vector 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, or more times. The order of administration may comprise administering the first adenovirus one or multiple times in a row followed by administering the second adenovirus vector one or multiple times in a row. In certain embodiments, the methods include alternating administration of the first and the second adenovirus vectors as one administration each, two administrations each, three administrations each, and so on. In certain embodiments, the first and the second adenovirus vectors are administered simultaneously. In other embodiments, the first and the second adenovirus vectors are administered sequentially. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

As would be readily understood by the skilled artisan, more than two adenovirus vectors may be used in the methods of the present invention. Three, 4, 5, 6, 7, 8, 9, 10 or more different adenovirus vectors may be used in the methods of the invention. In certain embodiments, the methods comprise administering more than one E2b deleted adenovirus vector at a time. In this regard, immune responses against multiple target antigens of interest can be generated by administering multiple different adenovirus vectors simultaneously, each comprising nucleic acid sequences encoding one or more target antigens. In some embodiments, the one or more target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

The present invention provides methods of generating an immune response against any target antigen, such as those described elsewhere herein.

In certain embodiments, the adenovirus vectors are used to generate an immune response against a cancer. In this regard, the methods include generating an immune response against carcinomas or sarcomas such as solid tumors, lymphomas or leukemias. Thus, the adenovirus vectors described herein are used to generate an immune response against a cancer including but not limited to carcinomas or sarcomas such as neurologic cancers, melanoma, non-Hodgkin's lymphoma, Hodgkin's disease, leukemias, plasmocytomas, adenomas, gliomas, thymomas, breast cancer, prostate cancer, colo-rectal cancer, kidney cancer, renal cell carcinoma, uterine cancer, pancreatic cancer, esophageal cancer, lung cancer, ovarian cancer, cervical cancer, testicular cancer, gastric cancer, multiple myeloma, hepatoma, acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), and chronic lymphocytic leukemia (CLL), or other cancers. In some embodiments, the target antigen comprises CEA, a fragment, a variant, or a variant fragment thereof.

Further, in this regard, the cancer target antigens may include but are not limited to antigens derived from a variety of tumor proteins. Illustrative tumor proteins useful in the present invention include, but are not limited to any one or more of, p53, HPV E6, HPV E7, MAGE-A1, MAGE-A2, MAGE-A3, MAGE-A4, MAGE-A6, MAGE-A10, MAGE-A12, BAGE, DAM-6, -10, GAGE-1, -2, -8, GAGE-3, -4, -5, -6, -7B, NA88-A, NY-ESO-1, MART-1, MC1R, Gp100, PSA, PSM, Tyrosinase, TRP-1, TRP-2, ART-4, CAMEL, CEA, Cyp-B, Her2/neu, hTERT, hTRT, iCE, MUC1, MUC2, PRAME, P15, RU1, RU2, SART-1, SART-3, WT1, AFP, β-catenin/m, Caspase-8/m, CEA, CDK-4/m, ELF2M, GnT-V, G250, HSP70-2M, HST-2, KIAA0205, MUM-1, MUM-2, MUM-3, Myosin/m, RAGE, SART-2, TRP-2/INT2, 707-AP, Annexin II, CDC27/m, TPI/mbcr-abl, ETV6/AML, LDLR/FUT, Pml/RARα, and TEL/AML1. These and other tumor proteins are known to the skilled artisan. In particular embodiments, the target antigen may be one of these and other tumor proteins, a fragment, a variant, or a variant fragment thereof.

Methods are also provided for treating or ameliorating the symptoms of any of the infectious diseases or cancers as described herein. The methods of treatment comprise administering the adenovirus vectors one or more times to individuals suffering from or at risk from suffering from an infectious disease or cancer as described herein. As such, the present invention provides methods for vaccinating against infectious diseases or cancers in individuals who are at risk of developing such a disease. Individuals at risk may be individuals who may be exposed to an infectious agent at some time or have been previously exposed but do not yet have symptoms of infection or individuals having a genetic predisposition to developing a cancer or being particularly susceptible to an infectious agent. Individuals suffering from an infectious disease or cancer described herein may be determined to express and/or present a target antigen, which may be use to guide the therapies herein. For example, an example can be found to express and/or present a target antigen and an adenovirus vector encoding the target antigen, a variant, a fragment or a variant fragment thereof may be administered subsequently.

The present invention contemplates the use of adenovirus vectors for the in vivo delivery of nucleic acids encoding a target antigen, or a fragment, a variant, or a variant fragment thereof. Once injected into a subject, the nucleic acid sequence is expressed resulting in an immune response against the antigen encoded by the sequence. The adenovirus vector vaccine is administered in an “effective amount”, that is, an amount of adenovirus vector that is effective in a selected route or routes of administration to elicit an immune response as described elsewhere herein. In certain embodiments, an effective amount is one that induces an immune response effective to facilitate protection or treatment of the host against the target infectious agent or cancer. The amount of vector in each vaccine dose is selected as an amount which induces an immune, immunoprotective or other immunotherapeutic response without significant adverse effects generally associated with typical vaccines. Once vaccinated, subjects may be monitored to determine the efficacy of the vaccine treatment. Monitoring the efficacy of vaccination may be performed by any method known to a person of ordinary skill in the art. In some embodiments, blood or fluid samples may be assayed to detect levels of antibodies. In other embodiments, ELISpot assays may be performed to detect a cell-mediated immune response from circulating blood cells or from lymphoid tissue cells.

The adenovirus vectors of the invention are generally prepared as known in the art (see e.g., Hodges et al., 2000 supra; or Amalfitano et al., 1998 supra). For example, in certain embodiments, tissue culture plates containing E.C7 or C-7 cells are infected with the adenovirus vector virus stocks at an appropriate MOI (e.g., 5) and incubated at 37° C. for 40 h. The infected cells are harvested, resuspended in an appropriate buffer such as 10 mM Tris-Cl (pH 8.0), and sonicated, and the virus is purified by two rounds of cesium chloride density centrifugation. In certain techniques, the virus containing band is desalted over a Sephadex CL-6B column (Pharmacia Biotech, Piscataway, N.J.), glycerol is added to a concentration of 12%, and aliquots are stored at −80° C. The titer of the stock is measured (e.g. by measurement of the optical density at 260 nm of an aliquot of the virus after SDS lysis). GMP procedures for producing appropriate Ad stocks for human administration are used where appropriate.

For administration, the adenovirus vector stock is combined with an appropriate buffer, physiologically acceptable carrier, excipient or the like. In certain embodiments, an appropriate number of adenovirus vector particles are administered in an appropriate buffer, such as, sterile PBS. In certain circumstances it will be desirable to deliver the adenovirus vector compositions disclosed herein subcutaneously, parenterally, intravenously, intramuscularly, or even intraperitoneally. In certain embodiments, solutions of the active compounds as free base or pharmacologically acceptable salts may be prepared in water suitably mixed with a surfactant, such as hydroxypropylcellulose. Dispersions may also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof and in oils. In other embodiments, E2b deleted adenovirus vectors may be delivered in pill form, delivered by swallowing or by suppository.

Illustrative pharmaceutical forms suitable for injectable use include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions, for example, see U.S. Pat. No. 5,466,468, which is herein incorporated by reference in its entirety. Fluid forms to the extent that easy syringability exists may be preferred. Forms that are stable under the conditions of manufacture and storage are within the bounds of this invention. In various embodiments, forms are preserved against the contaminating action of microorganisms, such as bacteria, molds and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (e.g., glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and/or vegetable oils. Proper fluidity may be maintained, for example, by the use of a coating, such as lecithin, by the maintenance of the required particle size in the case of dispersion and/or by the use of surfactants. The prevention of the action of microorganisms can be facilitated by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminum monostearate and gelatin.

In one embodiment, for parenteral administration in an aqueous solution, the solution should be suitably buffered if necessary and the liquid diluent first rendered isotonic with sufficient saline or glucose. These particular aqueous solutions are especially suitable for intravenous, intramuscular, subcutaneous and intraperitoneal administration. In this connection, a sterile aqueous medium that can be employed will be known to those of skill in the art in light of the present disclosure. For example, one dosage may be dissolved in 1 ml of isotonic NaCl solution and either added to 1000 ml of hypodermoclysis fluid or injected at the proposed site of infusion, (see for example, “Remington's Pharmaceutical Sciences” 15th Edition, pages 1035-1038 and 1570-1580, which is herein incorporated by reference in its entirety). Some variation in dosage will necessarily occur depending on the condition of the subject being treated. Moreover, for human administration, preparations will preferably meet sterility, pyrogenicity, and the general safety and purity standards as required by FDA Office of Biologics standards.

The carriers can further comprise any and all solvents, dispersion media, vehicles, coatings, diluents, antibacterial and antifungal agents, isotonic and absorption delaying agents, buffers, carrier solutions, suspensions, colloids, and the like. The use of such media and agents for pharmaceutical active substances is well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions. The phrase “pharmaceutically-acceptable” relates to molecular entities and compositions that do not produce an allergic or similar untoward reaction when administered to a human.

In certain embodiments, the adenovirus vectors of the invention may be administered in conjunction with one or more immunostimulants, such as an adjuvant. An immunostimulant refers to essentially any substance that enhances or potentiates an immune response (antibody and/or cell-mediated) to an antigen. One type of immunostimulant comprises an adjuvant. Many adjuvants contain a substance designed to protect the antigen from rapid catabolism, such as aluminum hydroxide or mineral oil, and a stimulator of immune responses, such as lipid A, Bortadella pertussis or Mycobacterium tuberculosis derived proteins. Certain adjuvants are commercially available as, for example, Freund's Incomplete Adjuvant and Complete Adjuvant (Difco Laboratories, Detroit, Mich.); Merck Adjuvant 65 (Merck and Company, Inc., Rahway, N.J.); AS-2 (SmithKline Beecham, Philadelphia, Pa.); aluminum salts such as aluminum hydroxide gel (alum) or aluminum phosphate; salts of calcium, iron or zinc; an insoluble suspension of acylated tyrosine; acylated sugars; cationically or anionically derivatized polysaccharides; polyphosphazenes; biodegradable microspheres; monophosphoryl lipid A and quil A. Cytokines, such as GM-CSF, IFN-γ, TNFα, IL-2, IL-8, IL-12, IL-18, IL-7, IL-3, IL-4, IL-5, IL-6, IL-9, IL-10, and/or IL-13, and others, like growth factors, may also be used as adjuvants.

Within certain embodiments of the invention, the adjuvant composition is preferably one that induces an immune response predominantly of the Th1 type. High levels of Th1-type cytokines (e.g., IFN-γ, TNFα, IL-2 and IL-12) tend to favor the induction of cell mediated immune responses to an administered antigen. In contrast, high levels of Th2-type cytokines (e.g., IL-4, IL-5, IL-6 and IL-10) tend to favor the induction of humoral immune responses. Following application of a vaccine as provided herein, a patient may support an immune response that includes Th1- and/or Th2-type responses. Within certain embodiments, in which a response is predominantly Th1-type, the level of Th1-type cytokines will increase to a greater extent than the level of Th2-type cytokines. The levels of these cytokines may be readily assessed using standard assays. For a review of the families of cytokines, see Mosmann and Coffman, Ann. Rev. Immunol. 7:145-173, 1989. Thus, various embodiments of the invention relate to therapies raising an immune response against a target antigen, for example CEA, using cytokines, e.g. IFN-γ, TNFα IL-2, IL-8, IL-12, IL-18, IL-7, IL-3, IL-4, IL-5, IL-6, IL-9, IL-10, and/or IL-13 supplied concurrently with a replication defective adenovirus vector treatment. In some embodiments, a cytokine or a nucleic acid encoding a cytokine, is administered together with a replication defective adenovirus described herein. In some embodiments, cytokine administration is performed prior or subsequent to adenovirus vector administration. In some embodiments, a replication defective adenovirus vector capable of raising an immune response against a target antigen, for example CEA, further comprises a sequence encoding a cytokine.

Certain illustrative adjuvants for eliciting a predominantly Th1-type response include, for example, a combination of monophosphoryl lipid A, preferably 3-de-O-acylated monophosphoryl lipid A, together with an aluminum salt. MPL® adjuvants are available from GlaxoSmithKlein (Research Triangle Park, N.C.; see, for example, U.S. Pat. Nos. 4,436,727; 4,877,611; 4,866,034 and 4,912,094, each incorporated herein by reference in its entirety). CpG-containing oligonucleotides (in which the CpG dinucleotide is unmethylated) also induce a predominantly Th1 response. Such oligonucleotides are well known and are described, for example, in WO 96/02555, WO 99/33488 and U.S. Pat. Nos. 6,008,200 and 5,856,462, each incorporated herein by reference in its entirety. Immunostimulatory DNA sequences are also described, for example, by Sato et al., Science 273:352, 1996. Another adjuvant for use in the present invention comprises a saponin, such as Quil A, or derivatives thereof, including QS21 and QS7 (Aquila Biopharmaceuticals Inc., Framingham, Mass.); Escin; Digitonin; or Gypsophila or Chenopodium quinoa saponins Other formulations may include more than one saponin in the adjuvant combinations of the present invention, for example combinations of at least two of the following group comprising QS21, QS7, Quil A, β-escin, or digitonin.

In certain embodiments, the compositions may be delivered by intranasal sprays, inhalation, and/or other aerosol delivery vehicles. The delivery of drugs using intranasal microparticle resins (Takenaga et al., J Controlled Release 1998 Mar. 2; 52(1-2):81-7) and lysophosphatidyl-glycerol compounds (U.S. Pat. No. 5,725,871, incorporated herein by reference in its entirety) are well-known in the pharmaceutical arts. Likewise, illustrative transmucosal drug delivery in the form of a polytetrafluoroetheylene support matrix is described in U.S. Pat. No. 5,780,045, incorporated herein by reference in its entirety.

In certain embodiments, liposomes, nanocapsules, microparticles, lipid particles, vesicles, and the like, are used for the introduction of the compositions of the present invention into suitable host cells/organisms. In particular, the compositions of the present invention may be formulated for delivery either encapsulated in a lipid particle, a liposome, a vesicle, a nanosphere, or a nanoparticle or the like. Alternatively, compositions of the present invention can be bound, either covalently or non-covalently, to the surface of such carrier vehicles.

The formation and use of liposome and liposome-like preparations as potential drug carriers is generally known to those of skill in the art (see for example, Lasic, Trends Biotechnol 1998 July; 16(7):307-21; Takakura, Nippon Rinsho 1998 March; 56(3):691-5; Chandran et al., Indian J Exp Biol. 1997 August; 35(8):801-9; Margalit, Crit. Rev Ther Drug Carrier Syst. 1995; 12(2-3):233-61; U.S. Pat. No. 5,567,434; U.S. Pat. No. 5,552,157; U.S. Pat. No. 5,565,213; U.S. Pat. No. 5,738,868 and U.S. Pat. No. 5,795,587, each specifically incorporated herein by reference in its entirety).

Liposomes have been used successfully with a number of cell types that are normally difficult to transfect by other procedures, including T cell suspensions, primary hepatocyte cultures and PC 12 cells (Renneisen et al., J Biol. Chem. 1990 Sep. 25; 265(27):16337-42; Muller et al., DNA Cell Biol. 1990 April; 9(3):221-9). Liposomes have been used effectively to introduce genes, various drugs, radiotherapeutic agents, enzymes, viruses, transcription factors, allosteric effectors and the like, into a variety of cultured cell lines and animals. Furthermore, the use of liposomes does not appear to be associated with autoimmune responses or unacceptable toxicity after systemic delivery.

In certain embodiments, liposomes are formed from phospholipids that are dispersed in an aqueous medium and spontaneously form multilamellar concentric bilayer vesicles (also termed multilamellar vesicles (MLVs).

Alternatively, in other embodiments, the invention provides for pharmaceutically-acceptable nanocapsule formulations of the compositions of the present invention. Nanocapsules can generally entrap compounds in a stable and reproducible way (see, for example, Quintanar-Guerrero et al., Drug Dev Ind Pharm. 1998 December; 24(12):1113-28, incorporated herein by reference in its entirety). To avoid side effects due to intracellular polymeric overloading, such ultrafine particles (sized around 0.1 μm) may be designed using polymers able to be degraded in vivo. Such particles can be made as described, for example, by Couvreur et al., Crit. Rev Ther Drug Carrier Syst. 1988; 5(1):1-20; zur Muhlen et al., Eur J Pharm Biopharm. 1998 March; 45(2):149-55; Zambaux et al. J Controlled Release. 1998 Jan. 2; 50(1-3):31-40; and U.S. Pat. No. 5,145,684, each incorporated herein by reference in its entirety.

Routes and frequency of administration of the therapeutic compositions described herein, as well as dosage, may vary from individual to individual, and from disease to disease, and may be readily established using standard techniques. In general, the pharmaceutical compositions and vaccines may be administered by injection (e.g., intracutaneous, intramuscular, intravenous or subcutaneous), intranasally (e.g., by aspiration), in pill form (e.g. swallowing, suppository for vaginal or rectal delivery). In certain embodiments, between 1 and 10 doses may be administered over a 52 week period. In certain embodiments, 6 doses are administered, at intervals of 1 month, and further booster vaccinations may be given periodically thereafter. Alternate protocols may be appropriate for individual patients. As such, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, or more doses may be administered over a 1 year period or over shorter or longer periods, such as over 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95 or 100 week periods. Doses may be administered at 1, 2, 3, 4, 5, or 6 week intervals or longer intervals.

A suitable dose is an amount of an adenovirus vector that, when administered as described above, is capable of promoting a target antigen immune response as described elsewhere herein. In certain embodiments, the immune response is at least 10-50% above the basal (i.e., untreated) level. In certain embodiments, the immune response is at least 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 100, 110, 125, 150, 200, 250, 300, 400, 500 or more over the basal level. Such response can be monitored by measuring the target antigen(s) antibodies in a patient or by vaccine-dependent generation of cytolytic effector cells capable of killing patient tumor or infected cells in vitro, or other methods known in the art for monitoring immune responses. Such vaccines should also be capable of causing an immune response that leads to an improved clinical outcome of the disease in question in vaccinated patients as compared to non-vaccinated patients. In some embodiments, the improved clinical outcome comprises treating disease, reducing the symptoms of a disease, changing the progression of a disease, or extending life.

In general, an appropriate dosage and treatment regimen provides the adenovirus vectors in an amount sufficient to provide therapeutic and/or prophylactic benefit. Such a response can be monitored by establishing an improved clinical outcome for the particular disease being treated in treated patients as compared to non-treated patients. The monitoring data can be evaluated over time. In some embodiments, the progression of a disease over time is altered. Such improvements in clinical outcome would be readily recognized by a treating physician. Increases in preexisting immune responses to a target protein can generally correlate with an improved clinical outcome. Such immune responses may generally be evaluated using standard proliferation, cytotoxicity or cytokine assays, which may be performed using samples obtained from a patient before and after treatment.

While one advantage of the present invention is the capability to administer multiple vaccinations with the same or different adenovirus vectors, particularly in individuals with preexisting immunity to Ad, the adenoviral vaccines of this invention may also be administered as part of a prime and boost regimen. A mixed modality priming and booster inoculation scheme may result in an enhanced immune response. Thus, one aspect of this invention is a method of priming a subject with a plasmid vaccine, such as a plasmid vector comprising a target antigen of interest, by administering the plasmid vaccine at least one time, allowing a predetermined length of time to pass, and then boosting by administering the adenovirus vector. Multiple primings, e.g., 1-4, may be employed, although more may be used. The length of time between priming and boost may typically vary from about four months to a year, but other time frames may be used. In certain embodiments, subjects may be primed 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or more times with plasmid vaccines, and then boosted 4 months later with the adenovirus vector.

Patient Selection

Various embodiments of the invention relate to compositions and methods for raising an immune response against one or more CEA antigens in selected patient populations. Accordingly, methods and compositions of the invention may target patients with a cancer including but not limited to carcinomas or sarcomas such as neurologic cancers, melanoma, non-Hodgkin's lymphoma, Hodgkin's disease, leukemias, plasmocytomas, adenomas, gliomas, thymomas, breast cancer, prostate cancer, colo-rectal cancer, kidney cancer, renal cell carcinoma, uterine cancer, pancreatic cancer, esophageal cancer, lung cancer, ovarian cancer, cervical cancer, testicular cancer, gastric cancer, multiple myeloma, hepatoma, acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), chronic myelogenous leukemia (CML), and chronic lymphocytic leukemia (CLL), or other cancers can be targeted for therapy. In some cases, the targeted patient population may be limited to individuals having colorectal adenocarcinoma, metastatic colorectal cancer, advanced CEA expressing colorectal cancer breast cancer, lung cancer, bladder cancer, or pancreas cancer. A histologically confirmed diagnosis of a selected cancer, for example colorectal adenocarcinoma, may be used. A particular disease stage or progression may be selected, for example, patients with one or more of a metastatic, recurrent, stage III, or stage IV cancer may be selected for therapy with the methods and compositions of the invention. In some embodiments, patients may be required to have received and, optionally, progressed through other therapies including but not limited to fluoropyrimidine, irinotecan, oxaliplatin, bevacizumab, cetuximab, or panitumumab containing therapies. In some cases, individual's refusal to accept such therapies may allow the patient to be included in a therapy eligible pool with methods and compositions of the invention. In some embodiments, individuals to receive therapy using the methods and compositions of the invention may be required to have an estimated life expectancy of at least, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 18, 21, or 24 months. The patient pool to receive a therapy using the methods and compositions of the invention may be limited by age. For example, individuals who are older than 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 25, 30, 35, 40, 50, 60, or more years old can be eligible for therapy with methods and compositions of the invention. For another example, individuals who are younger than 75, 70, 65, 60, 55, 50, 40, 35, 30, 25, 20, or fewer years old can be eligible for therapy with methods and compositions of the invention.

In some embodiments, patients receiving therapy using the methods and compositions of the invention are limited to individuals with adequate hematologic function, for example with one or more of a WBC count of at least 1000, 1500, 2000, 2500, 3000, 3500, 4000, 4500, 5000 or more per microliter, a hemoglobin level of at least 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 or higher g/dL, a platelet count of at least 50,000; 60,000; 70,000; 75,000; 90,000; 100,000; 110,000; 120,000; 130,000; 140,000; 150,000 or more per microliter; with a PT-INR value of less than or equal to 0.8, 1.0, 1.2, 1.3, 1.4, 1.5, 1.6, 1.8, 2.0, 2.5, 3.0, or higher, a PTT value of less than or equal to 1.2, 1.4, 1.5, 1.6, 1.8, 2.0×ULN or more. In various embodiments, hematologic function indicator limits are chosen differently for individuals in different gender and age groups, for example 0-5, 5-10, 10-15, 15-18, 18-21, 21-30, 30-40, 40-50, 50-60, 60-70, 70-80 or older than 80.

In some embodiments, patients receiving therapy using the methods and compositions of the invention are limited to individuals with adequate renal and/or hepatic function, for example with one or more of a serum creatinine level of less than or equal to 0.8, 0.9, 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2 mg/dL or more, a bilirubin level of 0.8, 0.9, 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9, 2.0, 2.1, 2.2 mg/dL or more, while allowing a higher limit for Gilbert's syndrome, for example, less than or equal to 1.5, 1.6, 1.8, 1.9, 2.0, 2.1, 2.2, 2.3, or 2.4 mg/dL, an ALT and AST value of less than or equal to less than or equal to 1.5, 2.0, 2.5, 3.0×upper limit of normal (ULN) or more. In various embodiments, renal or hepatic function indicator limits are chosen differently for individuals in different gender and age groups, for example 0-5, 5-10, 10-15, 15-18, 18-21, 21-30, 30-40, 40-50, 50-60, 60-70, 70-80 or older than 80.

In some embodiments, the K-ras mutation status of individuals who are candidates for a therapy using the methods and compositions of the invention can be determined. Individuals with a preselected K-ras mutational status can be included in an eligible patient pool for therapies using the methods and compositions of the invention.

In various embodiments, patients receiving therapy using the methods and compositions of the invention are limited to individuals without concurrent cytotoxic chemotherapy or radiation therapy, a history of, or current, brain metastases, a history of autoimmune disease, such as but not restricted to, inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis, scleroderma, multiple sclerosis, thyroid disease and vitiligo, serious intercurrent chronic or acute illness, such as cardiac disease (NYHA class III or IV), or hepatic disease, a medical or psychological impediment to probable compliance with the protocol, concurrent (or within the last 5 years) second malignancy other than non-melanoma skin cancer, cervical carcinoma in situ, controlled superficial bladder cancer, or other carcinoma in situ that has been treated, an active acute or chronic infection including: a urinary tract infection, HIV (e.g. as determined by ELISA and confirmed by Western Blot), and chronic hepatitis, or concurrent steroid therapy (or other immuno-suppressives, such as azathioprine or cyclosporin A). In some cases, patients with at least 3, 4, 5, 6, 7, 8, 9, or 10 weeks of discontinuation of any steroid therapy (except that used as pre-medication for chemotherapy or contrast-enhanced studies) may be included in a pool of eligible individuals for therapy using the methods and compositions of the invention.

In some embodiments, patients receiving therapy using the methods and compositions of the invention include individuals with thyroid disease and vitiligo.

Pre-Treatment Evaluation

In various embodiments, samples, for example serum or urine samples, from the individuals or candidate individuals for a therapy using the methods and compositions of the invention may be collected. Samples may be collected before, during, and/or after the therapy for example, within 2, 4, 6, 8, 10 weeks prior to the start of the therapy, within 1 week, 10 day, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, or 12 weeks from the start of the therapy, within 2, 4, 6, 8, 10 weeks prior to the start of the therapy, within 1 week, 10 day, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 9 weeks, or 12 weeks from the start of the therapy, in 1 week, 10 day, 2 week, 3 week, 4 week, 6 week, 8 week, 9 week, or 12 week intervals during the therapy, in 1 month, 3 month, 6 month, 1 year, 2 year intervals after the therapy, within 1 month, 3 months, 6 months, 1 year, 2 years, or longer after the therapy, for a duration of 6 months, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 years or longer. The samples may be tested for any of the hematologic, renal, or hepatic function indicators described herein as well as suitable others known in the art, for example a β-HCG for women with childbearing potential. In that regard, hematologic and biochemical tests, including cell blood counts with differential, PT, INR and PTT, tests measuring Na, K, Cl, CO₂, BUN, creatinine, Ca, total protein, albumin, total bilirubin, alkaline phosphatase, AST, ALT and glucose are within the bounds of the invention. In some embodiments, the presence or the amount of HIV antibody, Hepatitis BsAg, or Hepatitis C antibody are determined in a sample from individuals or candidate individuals for a therapy using the methods and compositions of the invention. Biological markers, such as antibodies to CEA or the neutralizing antibodies to Ad5 vector can be tested in a sample, such as serum, from individuals or candidate individuals for a therapy using the methods and compositions of the invention. In some cases, one or more samples, such as a blood sample can be collected and archived from an individuals or candidate individuals for a therapy using the methods and compositions of the invention. Collected samples can be assayed for immunologic evaluation. Individuals or candidate individuals for a therapy using the methods and compositions of the invention can be evaluated in imaging studies, for example using CT scans or MRI of the chest, abdomen, or pelvis. Imaging studies can be performed before, during, or after therapy using the methods and compositions of the invention, during, and/or after the therapy, for example, within 2, 4, 6, 8, 10 weeks prior to the start of the therapy, within 1 week, 10 day, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, or 12 weeks from the start of the therapy, within 2, 4, 6, 8, 10 weeks prior to the start of the therapy, within 1 week, 10 day, 2 weeks, 3 weeks, 4 weeks, 6 weeks, 8 weeks, 9 weeks, or 12 weeks from the start of the therapy, in 1 week, 10 day, 2 week, 3 week, 4 week, 6 week, 8 week, 9 week, or 12 week intervals during the therapy, in 1 month, 3 month, 6 month, 1 year, 2 year intervals after the therapy, within 1 month, 3 months, 6 months, 1 year, 2 years, or longer after the therapy, for a duration of 6 months, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 years or longer.

Treatment Plans

Dosage and Administration

Compositions and methods of the invention contemplate various dosage and administration regimens during therapy. Patients may receive a replication defective adenovirus or adenovirus vector, for example Ad5 [E1-, E2B-]-CEA(6D), that is capable of raising an immune response in an individual against a target antigen described herein, for example CEA. In various embodiments, the replication defective adenovirus is administered at a dose that suitable for effecting such immune response. In some cases, the replication defective adenovirus is administered at a dose that is greater than or equal to 1×10⁹, 2×10⁹, 3×10⁹, 4×10⁹, 5×10⁹, 6×10⁹, 7×10⁹, 8×10⁹, 9×10⁹, 1×10¹⁰, 2×10¹⁰, 3×10¹⁰, 4×10¹⁰, 5×10¹⁰, 6×10¹⁰, 7×10¹⁰, 8×10¹⁰, 9×10¹⁰, 1×10¹¹, 2×10¹¹, 3×10¹¹, 4×10¹¹, 5×10¹¹, 6×10¹¹, 7×10¹¹, 8×10¹¹, 9×10¹¹, 1×10¹², 1.5×10¹², 2×10¹², 3×10¹², or more virus particles (VP) per immunization. In some cases, the replication defective adenovirus is administered at a dose that is less than or equal to 1×10⁹, 2×10⁹, 3×10⁹, 4×10⁹, 5×10⁹, 6×10⁹, 7×10⁹, 8×10⁹, 9×10⁹, 1×10¹⁰, 2×10¹⁰, 3×10¹⁰, 4×10¹⁰, 5×10¹⁰, 6×10¹⁰, 7×10¹⁰, 8×10¹⁰, 9×10¹⁰, 1×10¹¹, 2×10¹¹, 3×10¹¹, 4×10¹¹, 5×10¹¹, 6×10¹¹, 7×10¹¹, 8×10¹¹, 9×10¹¹, 1×10¹², 1.5×10¹², 2×10¹², 3×10¹², or more virus particles per immunization. In various embodiments, a desired dose described herein is administered in a suitable volume of formulation buffer, for example a volume of about 0.1-10 ml, 0.2-8 ml, 0.3-7 ml, 0.4-6 ml, 0.5-5 ml, 0.6-4 ml, 0.7-3 ml, 0.8-2 ml, 0.9-1.5 ml, 0.95-1.2 ml, 1.0-1.1 ml. Those of skill in the art appreciate that the volume may fall within any range bounded by any of these values (e.g., about 0.5 ml to about 1.1 ml. The administration of the virus particles can be through a variety of suitable paths for delivery, for example it can be by injection (e.g., intracutaneous, intramuscular, intravenous or subcutaneous), intranasally (e.g., by aspiration), in pill form (e.g. swallowing, suppository for vaginal or rectal delivery. In some embodiments, a subcutaneous delivery may be preferred and can offer greater access to dendritic cells.

The administration of the virus particles to an individual may be repeated. The repeated deliveries of virus particles may follow a schedule or alternatively, may be performed on an as needed basis. For example, the individual's immunity against a target antigen, for example CEA, may be tested and replenished as necessary with additional deliveries. In some embodiments, schedules for delivery include administrations of virus particles at regular intervals. Joint delivery regimens may be designed comprising one or more of a period with a schedule and/or a period of need based administration assessed prior to administration. For example, a therapy regimen may include an administration, for example subcutaneous administration once every three weeks then another immunotherapy treatment every three months until removed from therapy for any reason including death. Another example regimen comprises three administrations every three weeks then another set of three immunotherapy treatments every three months. Another example regimen comprises a first period with a first number of administrations at a first frequency, a second period with a second number of administrations at a second frequency, a third period with a third number of administrations at a third frequency etc. and optionally one or more periods with undetermined number of administrations on an as needed basis. The number of administrations in each period can be independently selected and can for example be 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 or more. The frequency of the administration in each period can also be independently selected, can for example be about every day, every other day, every third day, twice a week, once a week, once every other week, every three weeks, every month, every six weeks, every other month, every third month, every fourth month, every fifth month, every sixth month, once a year etc. The therapy can take a total period of up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 30, 36 months or more. The scheduled interval between immunizations may be modified so that the interval between immunizations is revised by up to a fifth, a fourth, a third, or half of the interval. For example, for a 3-week interval schedule, an immunization may be repeated between 20 and 28 days (3 weeks −1 day to 3 weeks +7 days). For the first 3 immunizations, if the second and/or third immunization is delayed, the subsequent immunizations may be shifted allowing a minimum amount of buffer between immunizations. For example, for a three week interval schedule, if an immunization is delayed, the subsequent immunization may be scheduled to occur no earlier than 17, 18, 19, or 20 days after the previous immunization.

Compositions of the invention, such as Ad5 [E1-, E2b-]-CEA(6D) virus particles, can be provided in various states, for example, at room temperature, on ice, or frozen. Compositions may be provided in a container of a suitable size, for example a vial of 2 ml vial. In one embodiment, 1 2 ml vial with 1.0 ml of extractable vaccine contains 5×10¹¹ total virus particles/mL. Storage conditions including temperature and humidity may vary. For example, compositions for use in therapy may be stored at room temperature, 4° C., −20° C. or lower until used.

General Evaluations

In various embodiments, general evaluations are performed on the individuals receiving treatment according to the methods and compositions of the invention. One or more of any tests may be performed as needed or in a scheduled basis, such as on weeks 0, 3, 6 etc. A different set of tests may be performed concurrent with immunization vs. at time points without immunization.

General evaluations may include one or more of medical history, ECOG Performance Score, Karnofsky performance status, and complete physical examination with weight by the attending physician. Any other treatments, medications, biologics, or blood products that the patient is receiving or has received since the last visit may be recorded. Patients may be followed at the clinic for a suitable period, for example approximately 30 minutes, following receipt of vaccine to monitor for any adverse reactions. Local and systemic reactogenicity after each dose of vaccine will may be assessed daily for a selected time, for example for 3 days (on the day of immunization and 2 days thereafter). Diary cards may be used to report symptoms and a ruler may be used to measure local reactogenicity. Immunization injection sites may be assessed. CT scans or MRI of the chest, abdomen, and pelvis may be performed.

Hematological and Biochemical Assessment

In various embodiments, hematological and biochemical evaluations are performed on the individuals receiving treatment according to the methods and compositions of the invention. One or more of any tests may be performed as needed or in a scheduled basis, such as on weeks 0, 3, 6 etc. A different set of tests may be performed concurrent with immunization vs. at time points without immunization.

Hematological and biochemical evaluations may include one or more of blood test for chemistry and hematology, CBC with differential, Na, K, Cl, CO₂, BUN, creatinine, Ca, total protein, albumin, total bilirubin, alkaline phosphatase, AST, ALT, glucose, and ANA.

Biological Markers

In various embodiments, biological markers are evaluated on individuals receiving treatment according to the methods and compositions of the invention. One or more of any tests may be performed as needed or in a scheduled basis, such as on weeks 0, 3, 6 etc. A different set of tests may be performed concurrent with immunization vs. at time points without immunization.

Biological marker evaluations may include one or more of measuring antibodies to CEA or the Ad5 vector, from a serum sample of adequate volume, for example about 5 ml Biomarkers (e.g., CEA or CA15-3) may be reviewed if determined and available

Immunological Assessment

In various embodiments, an immunological assessment is performed on individuals receiving treatment according to the methods and compositions of the invention. One or more of any tests may be performed as needed or in a scheduled basis, such as on weeks 0, 3, 6 etc. A different set of tests may be performed concurrent with immunization vs. at time points without immunization.

Peripheral blood, for example about 90 mL may be drawn prior to each immunization and at a time after at least some of the immunizations, to determine whether there is an effect on the immune response at specific time points during the study and/or after a specific number of immunizations. Immunological assessment may include one or more of assaying peripheral blood mononuclear cells (PBMC) for T cell responses to CEA using ELISpot, proliferation assays, multi-parameter flow cytometric analysis, and cytoxicity assays. Serum from each blood draw may be archived and sent and determined.

Tumor Assessment

In various embodiments, a tumor assessment is performed on individuals receiving treatment according to the methods and compositions of the invention. One or more of any tests may be performed as needed or in a scheduled basis, such as prior to treatment, on weeks 0, 3, 6 etc. A different set of tests may be performed concurrent with immunization vs. at time points without immunization.

Tumor assessment may include one or more of CT or MRI scans of chest, abdomen, or pelvis performed prior to treatment, at a time after at least some of the immunizations and at approximately every three months following the completion of a selected number, for example 2, 3, or 4, of first treatments and for example until removal from treatment.

Rate of Immune Response

Immune responses against a target antigen described herein, such as CEA, may be evaluated from a sample, such as a peripheral blood sample of an individual using one or more suitable tests for immune response, such as ELISpot, cytokine flow cytometry, or antibody response. A positive immune response by ELISpot is described at the 2002 Society of Biologic Therapy Workshop on “Immunologic Monitoring of Cancer Vaccine Therapy”, i.e. a T cell response is considered positive if the mean number of spots adjusted for background in six wells with antigen exceeds the number of spots in six control wells by 10 and the difference between single values of the six wells containing antigen and the six control wells is statistically significant at a level of p<0.05 using the Student's t test. Immunogenicity assays may occur prior to each immunization and at scheduled timepoints during the period of the treatment. For example, a timepoint for an immunugenecity assay at around week 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 18, 20, 24, 30, 36, or 48 of a treatment may be scheduled even without a scheduled immunization at this time. In some cases, an individual may be considered evaluable for immune response if they receive at least a minimum number of immunizations, for example 1, 2, 3, 4, 5, 6, 7, 8, 9, or more immunizations.

Determination of Clinical Response

In some embodiments, disease progression or clinical response determination is made according to the RECIST 1.1 criteria among patients with measurable/evaluable disease.

In some embodiments, therapies using the methods and compositions of the invention affect a Complete Response (CR; disappearance of all target lesions for target lesions or disappearance of all non-target lesions and normalization of tumor marker level for non-target lesions) in an individual receiving the therapy.

In some embodiments, therapies using the methods and compositions of the invention affect a Partial Response (PR; at least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD for target lesions) in an individual receiving the therapy.

In some embodiments, therapies using the methods and compositions of the invention affect a Stable Disease (SD; neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started for target lesions) in an individual receiving the therapy.

In some embodiments, therapies using the methods and compositions of the invention affect an Incomplete Response/Stable Disease (SD; persistence of one or more non-target lesion(s) or/and maintenance of tumor marker level above the normal limits for non-target lesions) in an individual receiving the therapy.

In some embodiments, therapies using the methods and compositions of the invention affect a Progressive Disease (PD; at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions for target lesions or persistence of one or more non-target lesion(s) or/and maintenance of tumor marker level above the normal limits for non-target lesions) in an individual receiving the therapy.

EXAMPLES Example 1 Multiple Injections of Ad5Null Adenovirus Vector Produces Anti-Adenovirus Antibodies

This example shows that multiple injections of Ad5-null results in the production of anti-adenovirus antibodies in the injected subjects

It was demonstrated that the Ad5Null adenovirus vector that does not contain any heterologous nucleic acid sequences, generates a neutralizing immune response in mice. In particular, in one experiment, female Balb/c mice aged 5-7 weeks were immunized with Ad5Null viral particles at 14 day intervals. To determine the presence of anti-adenovirus antibodies, an enzyme linked immunosorbent assay (ELISA) was used. For this ELISA, 10⁹ viral particles were coated onto microtiter wells in 100 μL of 0.05M carbonate/bicarbonate buffer, pH 9.6, and incubated overnight at room temperature. For a standard immunoglobulin G (IgG) reference curve, 200 ng, 100 ng, 50 ng, 25 ng, and 0 ng of purified mouse IgG (Sigma Chemicals) were coated onto microtiter wells as described above. After incubation, all wells were washed 3 times with 250 μl of 1% bovine serum albumin (BSA) in phosphate buffered saline (PBS), pH 7.4. After washing, 250 μl of BSA/PBS was added to all and incubated for 30 minutes at room temperature to block unbound sites. After incubation, all wells were washed 3 times with 250 μL of BSA/PBS. After washing, 200 μl of a 1/100 serum dilution in BSA/PBS was added to wells and incubated for 1 hour at room temperature. For a positive control, 200 μl of a 1/10000 dilution of anti-adenovirus antiserum (Biodesign International) in BSA/PBS were added to wells. Control wells contained BSA/PBS only. After incubation, all wells were washed 3 times with 250 μl of BSA/PBS. After washing, 200 μL of a 1/10000 dilution of peroxidase conjugated gamma chain specific goat anti-mouse IgG (Sigma Chemicals) in BSA/PBS were added to each well and incubated for 1 hour at room temperature. After incubation, all wells were washed 3 times with 250 μL of BSA/PBS. After washing, 200 .mu.L of developing reagent (0.5 mg/mL 1,2 phenylenediamine in 0.2M potassium phosphate buffer, pH 5.0, containing 0.06% hydrogen peroxide) was added to each well and incubated for 30-40 minutes at room temperature. After incubation, the color reaction was stopped by addition of 50 .mu.L 5N HCl to each well. All wells were then read in a microwell plate reader at 492 nm. After readings were obtained, the optical density readings of unknown samples were correlated with the standard IgG curve to obtain the nanograms of IgG bound per well. This was performed using the INSTAT statistical package.

As shown in FIG. 1, significant levels (P<0.001) of anti-adenovirus IgG antibody were detected in mice 2 weeks after a first injection with 10¹⁰ Ad-5-null. A significantly higher level (P<0.001) was observed 2 weeks after a second injection with 10¹⁰ adenovirus. Significantly higher (P<0.001) levels of antibody were continued to be observed 2 weeks after a third injection with 10¹⁰ Ad5-null. Each value represents the average of triplicate determinations from pooled sera of 5 mice in each group. These results indicate that multiple injections of Ad5-null results in the production of anti-adenovirus antibodies in the injected subjects.

To determine the presence of neutralizing antibody to Ad, the following assay was utilized. A HEK-293T cell line was cultured in 200 .mu.L of culture medium consisting of DMEM containing 10% fetal calf serum (DMEM/FCS) in microwell tissue culture plates at a cell concentration of 2.times.10³ cells per well for 24 hours at 37 C in 5% CO.sub.2. After incubation, 100 .mu.L of culture medium was removed from triplicate wells and mixed with 20 .mu.L of DMEM/FCS containing viral particles (VP). After mixing, the 120 .mu.L mixture was added back to the respective microwells. In another set of triplicate wells, 100 .mu.L of culture medium was removed and mixed with 20 .mu.L of heat inactivated (56 C for 1 hour) Ad immune mouse serum previously incubated with VP for one hour at room temperature. After mixing, the 120 .mu.L mixture was added back to the respective wells. In triplicate cell control wells, 20 .mu.L of DMEM/FCS was added to control for total culture medium volume. Triplicate medium only control wells contained 220 .mu.L of DMEM/FCS. The tissue culture plate was incubated for an additional 3 days at 37 C in 5% CO.sub.2. After incubation, 40 .mu.L of PROMEGA cell viability reagent (Owen's reagent) was added to all wells and incubated for 75 minutes at 37 C in 5% CO.sub.2. In this assay, the Owen's reagent (MTS tetrazolium compound) is bioreduced by viable cells into a colored formazan product that is soluble in tissue culture medium. The quantity of formazan product as measured by absorbance at 490 nm is directly proportional to the number of living cells in culture. After incubation, 150 .mu.L was removed from each well and transferred to another microwell plate for optical density readings. Optical density readings at 492 nm were subsequently obtained using a microwell plate reader.

In an experiment to detect the presence of neutralizing antibodies to Ad, groups of 5 mice each were injected once, twice, or three times with 10¹⁰ Ad5null at two week intervals. Two weeks after the final injection of virus, mice were bled, pooled, and assessed for neutralizing antibody as described above using 4.times.10⁷ VP incubated with or without heat inactivated sera. Cells cultured alone served as a control group. As shown in FIG. 2, normal mice and mice injected one time with Ad5null did not exhibit significant levels of neutralizing antibody. Mice injected two times with Ad exhibited significant (P<0.05) levels of neutralizing antibody as compared with cells incubated with virus only. Mice injected three times with Ad5-null also exhibited significant (P<0.01) levels of neutralizing antibody as compared with cells incubated with virus only.

Example 2 The Ad5 [E1-]-CEA Vector Vaccine Induces CEA Specific Immune Response Upon Re-Immunization in Ad5 Immune Mice

This example shows that the Ad5 [E1-, E2b-] vector platform induces CMI responses against the tumor associated antigen (TAA) carcinoembryonic antigen (CEA) in the presence of pre-existing Ad5 immunity in mice.

Characterization of Ad5 CEA Vectors

Initial studies were performed to confirm CEA gene expression of two Ad5-CEA vector platforms. It was first determined that the CEA antigen could be expressed on cells transfected with the vaccine vector platforms. A549 cells were obtained from ATCC and transfected with Ad5 [E1-]-CEA or Ad5 [E1-, E2b-]-CEA. Western blot analysis revealed that cells transfected with the vector platforms expressed CEA antigen.

Induction of Ad5 Immunity in Mice

To assess the levels of Ad5 immunity that could be induced, groups of Ad5 naive C57BI/6 mice were injected subcutaneously with the Ad5 vector platform (VP). Twenty eight to forty two days later, serum samples were collected and assessed for endpoint Ad5 NAb titers. As shown in FIG. 3, undetectable Ad5 NAb titers (endpoint Ad5 NAb titer<1/25) were observed in normal control mice. Ad5 NAb (endpoint titers of 1/25 to 1/50) was detectable after one injection but dramatically increased after three injections of 10¹⁰ Ad5. Therefore, in additional Ad5 immune studies, mice were injected twice with 10¹⁰ Ad5 VP to render the animals Ad5 immune.

Immunization of Ad5 Immune Mice with Ad5 [E1-]-CEA or Ad5 [E1-, E2b-]-CEA.

These experiments were designed to determine and compare the immunization induction potential of Ad5 [E1-]-CEA and Ad5 [E1-, E2b-]-CEA vaccines in Ad5 immune mice. Groups of female C57BI/6 mice, 4 to 8 weeks old, were immunized 2 times at 2 week intervals with 10¹⁰ Ad5-null VP. Two weeks following the last Ad5-null immunization, the mice were immunized 3 times at weekly intervals with 10¹⁰ VP of Ad5 [E1-]-CEA or Ad5 [E1-, E2b-]-CEA. Two weeks following the last immunization, mice were euthanized and their spleens and sera harvested for analyses.

CMI responses were assessed by ELISpot assays performed on splenocytes exposed to intact CEA antigen. Splenocytes from Ad5 immune C57BI/6 mice that were immunized subcutaneously with Ad5 E1-]-CEA or Ad5 [E1-, E2b-]-CEA were harvested and assessed for the number of IFN-γ and IL-2 secreting cells as described above. As shown in FIGS. 4A and 4B, significantly elevated numbers of both IFN-γ and IL-2 secreting cells were observed in spleens assayed from mice immunized with Ad5 [E1-, E2b-]-CEA as compared to immunized Ad5 [E1-]-CEA mice. Specificity studies revealed that immunizations with Ad5 CEA vectors induced specific CEA associated CMI responses and not responses against other irrelevant antigens such as the HIV-gag protein or β-galactosidase. These results demonstrate that immunization of Ad5 immune mice with Ad5 [E1-, E2b-]-CEA induce significantly higher CMI responses.

Lack of Adverse Liver Effects in Immunized Mice

Toxicity studies were performed on serum from Ad5 immune female C57BI/6 mice immunized with Ad5 [E1-]-CEA, Ad5 [E1-, E2b-]-CEA as described above. Ad5 naive or Ad5 immune mice injected with buffer alone served as controls. Three days after the third immunization, aspartate aminotransferase (AST) levels were assessed on the blood samples to determine liver toxicity due to the treatment. AST levels were not elevated over controls following immunization with either vector (FIG. 5). Alanine aminotransferase (ALT) levels were also assessed and similar results were observed.

Ad5 [E1-, E2b-]-CEA Immunotherapy in Ad5 Immune Tumor Bearing Mice

Based upon the successful immunological results observed above, studies in which MC38 tumors were established in mice and then treated were performed as described below. For these studies a CEA expressing MC38 murine cell line was used. This cell line has been genetically modified to express human CEA and can be implanted into C57BI/6 mice. After tumor establishment, the mice were treated with the novel Ad5 [E1-, E2b-]-CEA vector platform. To determine if Ad5 immune tumor bearing mice could be treated with the Ad5 [E1-, E2b-]-CEA vector, C57BI/6 mice were injected two times subcutaneously with 10¹⁰ Ad5 [E1-]-null VP at 14 day intervals to render the mice Ad5 immune. Two weeks after the last injection, two groups of 7 C57BI/6 mice were injected subcutaneously with 10⁶ CEA expressing MC38 tumor cells. Seven days later, when tumors were palpable, one group of mice was treated by distal subcutaneous injection with 10¹⁰ VP of Ad5 [E1-, E2b-]-CEA on days 7, 13 and 19. A group of 7 injection buffer only treated C57BI/6 mice served as untreated controls. All mice were monitored for tumor size over a 21 day period and tumor volumes were determined as previously described.

As shown in FIG. 6, the tumor growth by day 19 was significantly reduced in the Ad5 [E1-, E2b-]-CEA treated mice and remained so. At the end of the study (Day 22), the mice were sacrificed and the tumors were excised and weighed. As shown in FIG. 7, the tumors in the mice treated with Ad5 [E1-, E2b-]-CEA were significantly (P<0.05) smaller in weight than the untreated controls.

At the termination of the study, spleens were collected from mice and the CEA specific CMI response was determined by ELISpot assay. CEA specific IFN-γ secretion response was significantly higher in mice immunized with Ad5 [E1-, E2b-]-CEA than in mice who received MC-38 tumor cells alone. These results indicate that treatment of CEA expressing tumors in Ad5 immunized mice using the Ad5 [E1-, E2b-]-CEA vaccine can significantly decrease tumor growth progression.

Example 3 Quantitative ELISA for CEA Expression on A549 Cells after Infection Experimental Design

On day one, of the assay a BD Falcon Tissue Culture 96-well plate was seeded with A549 cells passaged three days prior (lot#30Jul02, passage p+23), (7.7×10³ cells/well) and placed into a 37±2° C. incubator with a 5±2% CO₂ atmosphere overnight. The next day, a dilution series of the test article were prepared and replicate wells were inoculated at levels ranging from 1.56×10³ to 2.5×10⁴ viral particles/well. Untreated A549 cells were used to serve as the mock sample. On day four of the assay wells were treated with a 10% Triton X-100 solution for analysis by ELISA to measure CEA concentration.

For the ELISA, a microtiter plate was coated overnight with an anti-CEA capture antibody (abcam Carcino embryonic antigen CEA antibody [(NCRC16(AKA161)] catalog number ab2077, lot #201993. The wells were washed to remove unbound reactants, and the plate was blocked with a Phosphate Buffered Saline (PBS) solution containing 1% Tween 20. to fall within the range of the standard curve. After the blocking period, the wells were washed, and samples, controls, and standards were incubated in assigned triplicate wells. Unbound reactants were removed by washing, and a rabbit polyclonal to CEA detection antibody (abcam carcino embryonic antigen CEA antibody catalog# ab15987, lot#898335) was added. After incubation, the wells were washed and incubated with 3,31′,5,5′-tetramethylbenzidine (TMB), the peroxidase substrate. The substrate formed a colored product in the presence of the enzyme, reaction was stopped with 1M phosphoric acid solution, and the absorbance was determined on a calibrated microplate reader. A calibration curve was generated from standards containing known concentrations of CEA, and the curve was used to determine the concentration of CEA in the samples

Test Evaluation

The quantity of CEA produced per virus particle was calculated from the concentration of CEA measured by ELISA, after adjusting for dilution and multiplicity of infection (MOI). The value determined in a similar manner for culture media alone was subtracted to compensate for background levels present in the media. The sample analysis is shown in Table 1.

TABLE 1 Sample Analysis A₄₅₀- ELISA AVG Total A₅₄₀ Blank Dil'n CEA CEA CEA CEA Sample ID Rep 1 Rep 2 Mean SD RSD Subtr Fact ng/ml ng/ml ng/ml Ng/vp 10-002917 Well 1 at 1.3387 1.2977 1.318 0.029 2.2% 1.244 1000 7,731 7,691 7,621 0.30 2.5E+04 vp 0.7121 0.6789 0.693 0.023 3.4% 0.622 2000 7,797 10-002917 Well 2 at 1.1717 1.1329 1.152 0.027 2.4% 1.078 1000 6,563 2.5E+04 vp 0.6222 0.6151 0.619 0.005 0.8% 0.545 2000 6,975 10-002917 Well 3 at 1.1659 2.0492 1.608 0.625 38.9% 1.534 1000 10,264 2.5E+04 vp 0.6131 0.5946 0.604 0.013 2.2% 0.530 2000 6,815 10-002917 Well 1 at 1.1051 1.0759 1.091 0.021 1.9% 1.017 1000 6,169 6,049 5,979 0.48 1.25E+04 vp 0.5970 0.5716 0.584 0.018 3.1% 0.510 2000 6,602 10-002917 Well 2 at 1.0652 1.0376 1.051 0.020 1.9% 0.977 1000 5,919 1.25E+04 vp 0.5726 0.5770 0.575 0.003 0.5% 0.501 2000 6,506 10-002917 Well 3 at 0.9731 0.9514 0.962 0.015 1.6% 0.888 1000 5,383 1.25E+04 vp 0.5049 0.4970 0.501 0.006 1.1% 0.427 2000 5,716 10-002917 Well 1 at 0.7601 0.7210 0.741 0.028 3.7% 0.667 1000 4,141 4,286 4,216 0.67 6.25E+03 vp 0.4041 0.3881 0.396 0.011 2.9% 0.322 2000 4,566 10-002917 Well 2 at 0.7157 0.7068 0.711 0.006 0.9% 0.637 1000 3,979 6.25E+03 vp 0.3893 0.3843 0.387 0.004 0.9% 0.313 2000 4,465 10-002917 Well 3 at 0.7360 0.7188 0.727 0.012 1.7% 0.653 1000 4,065 6.25E+03 vp 0.3995 0.3807 0.390 0.013 3.4% 0.316 2000 4,499 10-002917 Well 1 at 0.8920 0.8878 0.890 0.003 0.3% 0.816 500 2,483 2,690 2,620 0.84 3.13E+03 vp 0.4573 0.4613 0.459 0.003 0.6% 0.385 1000 2,631 10-002917 Well 2 at 0.8615 0.8544 0.858 0.005 0.6% 0.784 500 2,393 3.13E+03 vp 0.4425 0.4406 0.442 0.001 0.3% 0.368 1000 2,538 10-002917 Well 3 at 1.0518 1.0464 1.049 0.004 0.4% 0.975 500 2,953 3.13E+03 vp 0.5519 0.5565 0.554 0.003 0.6% 0.480 1000 3,141 10-002917 Well 1 at 1.8771 1.8616 1.869 0.011 0.6% 1.795 100 1,351 1,271 1,201 0.77 1.56E+03 vp 1.1963 1.1695 1.183 0.019 1.6% 1.109 200 1,354 10-002917 Well 2 at 1.7435 1.7436 1.744 0.000 0.0% 1.670 100 1,179 1.56E+03 vp 1.0960 1.0788 1.087 0.012 1.1% 1.013 200 1,229 10-002917 Well 3 at 1.7801 1.8098 1.795 0.021 1.2% 1.721 100 1,245 1.56E+03 vp 1.1041 1.1263 1.115 0.016 1.4% 1.041 200 1,264 10-002917 Well 1 1.2509 1.2278 1.239 0.016 1.3% 1.165 10 72 70 0 — Mock 0.7146 0.6952 0.705 0.014 1.9% 0.631 20 79 10-002917 Well 2 1.2290 1.2382 1.234 0.007 0.5% 1.160 10 71 Mock 0.7246 0.7133 0.719 0.008 1.1% 0.645 20 80 10-002917 Well 3 0.9769 0.9750 0.976 0.001 0.1% 0.902 10 55 Mock 0.5579 0.5454 0.552 0.009 1.6% 0.478 20 63

Example 4 Schedule, Dose, Route of Immunization Safety Data

Initial studies were performed to evaluate and confirm that an Ad5 [E1-, E2b-] vector platform could express the antigen proteins on transfected cells. A-549 cells were transfected with vaccine platforms and analyzed by Western Blot Analysis. Antigen proteins such as HIV-gag, HIV-pol, or HIV-nef were observed to be expressed on cells once they were transfected with the Ad5 [E1-, E2b-] vector platforms. A representative Western Blot is presented in FIG. 8.

A dose response evaluation was performed using the Ad5 [E1-, E2b-] vector platform and demonstrated that 10¹⁰ virus particles (VP) is a dose that results in a desired CMI response against a transgene product in a murine model. CMI responses were assessed by utilizing an ELISpot assay to detect interferon-gamma (IFN-γ) and IL-2 secreting cells (splenocytes) from spleens of mice. Furthermore, in murine and non-human primate (NHP) models, three immunizations using 10¹⁰ VP separated by two weeks to four weeks, respectively, resulted in the desired CMI responses. In mice, a greater degree of CMI responses were observed after multiple immunizations as compared with one immunization only (FIG. 9).

In a NHP model, the animals were rendered Ad5 immune by injection with wild type Ad5 virus. After detection of the presence of Ad5 neutralizing antibody, which confirmed that the animals were immune to Ad5, the animals were vaccinated with an Ad5 [E1-, E2b-] vector platform three times at monthly intervals. As shown in FIG. 10, after immunizations, the presence of robust CMI responses was detected, when peripheral blood mononuclear cells (PBMCs) of animals were assessed for IFN-γ and IL-2 secreting cells.

In addition to the preliminary immunology studies performed in the initial vaccine trial in 3 NHP shown above, toxicity studies were also performed on the same NHP vaccinated with Ad5 [E1-, E2b-]-HIV gag. Animal temperatures and weights were assessed during the study period. The animals gained weight as they grew during the study period. No temperature differences were observed during the study period. Hematology studies were also performed on the vaccinated NHP.

There appeared to be a small increase in the white blood cell count 2 weeks after the second vaccination that normalized thereafter.

Other than fluctuation in values, there appeared to be no other differences in hematology values during the course of the study. Chemistry values were also determined in the NHP during the course of the study. Alkaline phosphatase levels declined slightly during the course of the study but remained in the normal range. Albumin levels declined slightly during the course of the study but remained in the normal. There were no other differences observed in the blood chemistries during the course of the study. The route of immunization in this clinical study is chosen since the preponderance of DC reside in the dermis.

A desired level of CMI response was induced using the Ad5 [E1-, E2b-] platform employing CEA and other transgenes. Using an Ad5 [E1-, E2b-]-CEA vector platform, both non-Ad5 immune and Ad5 pre-immunized mice were injected three times with the vaccine. After immunizations, the splenocytes from mice were assessed by ELISpot for IFN-γ secreting cells. As shown in FIG. 11, elevated CMI responses were observed after immunizations and the levels of CMI responses were similar in both non-Ad5 immune and Ad5 pre-immunized mice. These results indicate that robust CMI responses can be induced despite the presence of pre-existing Ad5 immunity. A III clinical study was designed using three immunizations separated by three weeks via a needle subcutaneous delivery method.

Rationale for Schedule, Dose, Route of Administration

A clinical study design flowed from pre-clinical and clinical studies in animals and humans using the Ad5 [E1-, E2b-] vector platform. A dose response evaluation using the Ad5 [E1-, E2b-] vector platform was performed demonstrating that 10¹⁰ virus particles (VP) is a dose which results in a desired CMI response against a transgene product in a murine model. Furthermore, in murine and non-human primate (NHP) models three immunizations using 10¹⁰ VP separated by two to four weeks respectively resulted in the desired CMI. The route of immunization is chosen since a preponderance of dendritic cells (DC) reside in the dermis. Using this premise, multiple murine and NHP studies were performed using a sub-cutaneous injection protocol. A desired level of circulating CMI was induced using the Ad5 [E1-, E2b-] platform employing CEA and other transgenes. A phase III clinical study followed using three immunizations separated by three weeks via a needle subcutaneous (SQ) delivery method continuing immunotherapy treatment every three months until removed from study for any reason including death.

Construction and Production of Ad5 [E1-, E2b-]-CEA(6D).

The cDNA sequence containing the modified CEA with the CAP1(6D) mutation was produced. Clinical grade Ad5 [E1-, E2b-]-CEA(6D) was constructed as previously described (Gabitzsch et al. (2010) Anti-tumor immunity despite immunity to adenovirus using a novel adenoviral vector Ad5 [E1-, E2b-]-CEA. Cancer Immunol Immunoother 59:1131-1135) and manufactured using the E.C7 cell line.

Summary

A total of 34 patients (32 colorectal cancer patients, one bladder cancer patient, and one lung cancer patient) were entered into the Phase I/II clinical study under IND14325. The majority received all three scheduled immunotherapy treatments with ETBX-011(Ad5 [E1-, E2b-]-CEA(6D)). Five patients who stopped immunotherapy early did so due to significant disease progression. RECIST 1.0 criteria using CT or MRI scans obtained at baseline and after treatments were completed. Toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Peripheral blood carcinoembryonic antigen (CEA) levels, hematology, serum chemistries, and anti-nuclear antibody titers were compared between baseline and 9 weeks following the initiation of immunotherapy. Survival was measured from the day of the first immunization until death from any cause.

A total of 94 treatments were administered to patients. No dose limiting toxicity or serious adverse events (SAE) that resulted in treatment discontinuation at any treatment dose level. There was only one significant change in a blood hematology value. As a group, the basophil count was significantly lower at week 9, three weeks after treatment ended. However, this value remained in the normal range for basophil counts and, overall, there appeared to be no significant biological effect. With a median follow-up of 7.4 months, all 34 patients as a group (cohorts 1, 2, 3/phase II, and cohort 5) experienced a 12-month survival proportion of 41.4%. Of the 34 patients entered into the study, 28 patients received the three immunotherapy treatments and experienced a 12-month survival proportion of 55%. For the colorectal adenocarcinoma patients, 27 patients received the three immunotherapy treatments and experienced a 12-month survival proportion of 53%. A dose response to increasing levels of ETBX-011 was observed with the highest cell-mediated immune (CMI) responses occurring in patients that received the highest dose of 5×10¹¹ VP of ETBX-011. When the highest CEA specific CMI responses were compared with pre-existing or vector induced Ad5 NAb activity, there was no correlation between levels of CEA specific CMI and Ad5 neutralizing antibody (NAb) level. These clinical trial data lead us to believe that there is sufficient data to advance to a randomized Phase III trial for the treatment of metastatic colorectal adenocarcinoma with overall survival as the clinical endpoint.

Protocol Schema and Patient Treatment.

The clinical study was performed under an FDA-approved Investigational New Drug Exemption and registered at ClinicalTrials.gov. Participants were recruited from medical oncology clinics at Duke University Medical Center, Durham, N.C. and Medical Oncology Associates, Spokane, Wash. Patients provided informed consent approved by the respective Institutional Review Boards (IRB). Eligibility requirements included metastatic cancer expressing CEA and adequate hematologic, renal, and hepatic function. Trial participants were required to have received treatment with standard therapy known to have a possible overall survival benefit or refused such therapy. Exclusion criteria included chemotherapy or radiation within the prior 4 weeks, history of autoimmune disease, viral hepatitis, HIV, or use of immunosuppressives. Patients who had been receiving bevacizumab or cetuximab for at least 3 months prior to enrollment were permitted to continue receiving these antibodies. Prior CEA immunotherapy was permitted. The study employed a standard 3+3 dose escalation strategy with dose limiting toxicities (DLT) defined as grade 3 or 4 major organ toxicity. The Ad5 [E1-, E2b-]-CEA(6D) doses were delivered to patients as follows: cohort 1: dose of 1×10⁹ VP in 0.5 ml subcutaneously (SQ) in the same thigh every 3 weeks for 3 immunizations; cohort 2: dose of 1×10¹⁰ VP in 0.5 ml SQ every 3 weeks for 3 treatments; cohort 3: dose of 1×10¹¹ in 0.5 ml SQ every 3 weeks for 3 treatments. Following establishment of the dose of 1×10¹¹ VP as safe, an additional 12 patients received Ad5 [E1-, E2b-]-CEA(6D) at this dose and schedule (phase II cohort). After completing the phase II cohort, an additional cohort (cohort 5) of six (6) patients received a dose of 5×10¹¹ VP in 2.5 ml SQ every 3 weeks for 3 treatments to determine safety of the highest achievable dose. PMBC were collected from patients just prior to the immunizations at weeks 0, 3, 6, and three weeks following the last treatment. The PBMC were frozen in liquid nitrogen until ELISpot assays were performed. In cohort 5, fresh PBMC were analyzed in preliminary flow cytometry assays for polyfunctional CD8+T lymphocytes.

Assessment of Clinical Activity.

Clinical activity was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST 1.0 criteria) using computed tomography (CT) or magnetic resonance imaging (MRI) scans obtained at baseline and after treatments were completed. Toxicity was assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 4. Peripheral blood CEA levels, hematology, serum chemistries, and anti-nuclear antibody titers were compared at baseline and 3 weeks following the final treatment. Survival was measured from the day of the first immunization until death from any cause.

Analysis of CMI Responses by ELISpot Assay.

An ELISpot assay for IFN-γ secreting lymphocytes was adapted from our previous animal studies and performed as described (Gabitzsch et al. (2010) Anti-tumor immunity despite immunity to adenovirus using a novel adenoviral vector Ad5 [E1-, E2b-]-CEA. Cancer Immunol Immunoother 59:1131-1135). Briefly, isolated PBMCs (2×10⁵ cells/well) from individual patient samples were incubated 36-40 hours with a CEA peptide pool (15mers with 11aa overlap covering full length CEA with the 6D modification; 0.1 m/well) to stimulate IFN-γ producing T cells. CMI responses to Ad5 were determined after exposure of patient PBMC to Ad5-null (empty vector). Cells stimulated with concanavalin A (Con A) at a concentration of 0.25 μg/well served as positive controls. Colored spot-forming cells (SFC) were counted using an Immunospot ELISpot plate reader (Cellular Technology, Shaker Heights, Ohio) and responses were considered to be positive if 50 SFC were detected/106 cells after subtraction of the negative control and SFC were ≧2-fold higher than those in the negative control wells.

Determination of Ad5 Neutralizing Antibody (NAb) Titers.

Endpoint Ad5 NAb titers were determined. Briefly, dilutions of heat inactivated test sera in 100 μL of DMEM containing 10% fetal calf serum were mixed with 4×107 VP of Ad5 [E1-]-null and incubated for 60 minutes at room temperature. The samples were added to microwells containing HEK293 cells cultured in DMEM containing 10% heat inactivated calf serum at 2×103 cells/well for 24 hours at 37° C. in 5% CO2. The mixture was incubated for an additional 72 hours at 37° C. in 5% CO2. An MTS tetrazolium bioreduction assay (Promega Corp. Madison, Wis.) was used to measure cell killing and endpoint Ad5 NAb titers. Endpoint titers with a value less than 1:25 were assigned a value of 0.

Statistics.

Statistical analyses comparing immune responses were performed employing the Mann-Whitney test (PRISM, Graph Pad). Survival comparisons were performed employing Kaplan-Meier plots (PRISM, Graph Pad). Ad5 NAb titer and CEA-specific CMI were analyzed as continuous variables. The association of Ad5 NAb titer with change in CEA-specific CMI was tested with the Spearman correlation coefficient. The association of Ad5 NAb titer with survival was tested with the Wald test of the proportional hazards model. All tests used a 2-sided alpha of 0.05.

Demographics: All Patients

Thirty two patients with metastatic colorectal cancer, one with lung cancer and one with bladder cancer, median age 58 (range 38-77), who had failed a median of three prior chemotherapeutic regimens (range: 2→5), had a median performance status of 90% (range 70-100%), and had a median of three sites of metastatic disease (range 1-5), were enrolled (Table 2). The majority of patients was able to receive all three immunizations. Five patients who stopped immunizations prior to completion of all three treatments did so due to significant disease progression.

TABLE 2 Patient Demographics ++ Patient # Disease CEA CEA ID/ Dose prior Mets # of status Survival Base- Week Cohort (VP) Dx Age Sex KPS CTx (# of sites) doses after tx (Months) line 9 002/1 10⁹  C 67 M 70 >3 4 3 PD 3 (−) 98.8 867.4 003/1 10⁹  R 63 M 100 5 2 3 PD 9 (−) 195.1 472.2 004/1 10⁹  C 53 F 100 2 3 3 PD 11 (−)  65.4 196.8 005/2 10¹⁰ C 60 M 100 3 3 3 SD 12 (+)  2.5 3.7 (7 month follow-up) 007/2 10¹⁰ C 52 M 80 2 5 1 PD 1 (−) 120.7 Not Done 008/2 10¹⁰ C 42 F 100 3 3 3 PD 12 (+)  3.0 3.1 010/2 10¹⁰ C 58 M 90 3 3 3 PD 12 (−)  7.1 5.8 011/3 10¹¹ R 50 M 100 5 1 3 PD 12 (+)  21.0 25.9 012/3 10¹¹ C 48 M 100 1 2 3 PD 12 (+)  5.8 18.4 013/3 10¹¹ R 62 M 100 3 2 2 PD 4 (−) 172.9 Not Done 500/3 10¹¹ C 55 M 80 4 3 3 PD 12 (+)  3.2 11.5 015/3 10¹¹ C 58 F 80 3 4 3 PD 10 (−)  2.0 2.4 016/3 10¹¹ C 53 F 100 3 4 3 PD 6 (−) 6.1 12.7 017/3* 10¹¹ R 52 F 90 3 2 3 PD 3 (−) 204.8 Not Done 501/II 10¹¹ R 54 M 90 1 1 3 PD 12 (+)  17.1 96.4 502/II 10¹¹ C 66 F 80 1 2 2 PD 3 (−) 2549.5 Not Done 503/II 10¹¹ Bl 73 M 70 4 5 1 PD 0.25 (−)   Not Not Done Done 019/II 10¹¹ C 69 M 90 1 3 3 PD 12 (+)  264.3 638.0 020/II{circumflex over ( )} 10¹¹ C 59 M 100 5 4 3 SD 12 (+)  2.2 2.2 021/II{circumflex over ( )} 10¹¹ C 51 F 100 4 3 3 PD 12 (+)  2.0 2.7 506/II 10¹¹ C 77 F 80 2 2 3 PD 3 (−) 16.5 38.2 023/II 10¹¹ C 51 F 100 3 4 3 PD 4 (−) 32.4 211.4 504/II 10¹¹ C 57 M 90 3 3 3 PD 12 (+)  424.7 2073.6 507/II 10¹¹ R 58 M 90 2 2 3 PD 12 (+)  <0.5 0.6 508/II 10¹¹ L 67 M 100 2 0 3 Unknown 12 (+)  109.2 Not Done 024/II 10¹¹ C 67 M 90 2 3 3 PD 12 (+)  7.8 6.4 025/II 10¹¹ C 62 F 100 2 4 3 PD 7 (−) 391.2 Not Done 026/II 10¹¹ C 53 M 100 3 2 2 PD 4 (−) 4057.5 7859.1 (treatment #2) 030/5 5 × 10¹¹ C 38 M 90 4 3 3 PD 8 (+) 9.2 18.7 031/5 5 × 10¹¹ R 72 F 90 4 2 3 SD 7 (+) 3.9 5.6 032/5 5 × 10¹¹ R 53 M 90 4 3 3 PD 6 (−) 31.9 75.4 @ 033/5 5 × 10¹¹ R 48 F 90 >3 2 3 PD 5 (−) 21.3 21.1 @ 034/5 5 × 10¹¹ C 62 M 100 5 4 3 PD 6 (+) 1.9 2.4 035/5 5 × 10¹¹ C 60 F 90 3 5 2 PD 2 (−) 9.5 Not Done Dx = diagnosis (Bl = bladder cancer; C = colon cancer; L = lung cancer; R = rectal cancer) KPS = Karnofsky Performance Status *concurrent cetuximab; {circumflex over ( )}concurrent bevacizumab; @ concurrent panitumumab ++ Represents disease status at 9 weeks post-initiation of immunizations PD = Progressive Disease; SD = Stable Disease (+) Alive; (−) Dead at last follow-up; survival rounded off to nearest month

Demographics: Colorectal Adenocarcinoma Patients

Thirty two patients, median age 57.5 (range 38-77) with metastatic colorectal cancer, who had failed a median of three prior chemotherapeutic regimens (range: 2→5), had a median performance status of 90% (range 70-100%), and had a median of three sites of metastatic disease (range 1-5), were enrolled (Table 2). The majority was able to receive all three immunizations. Four patients who stopped immunizations early did so due to significant disease progression. The colorectal adenocarcinoma patient demographics, albeit limited in size, compares favorably with previously published studies of patients with chemotherapy-refractory colorectal cancer (3-5).

Adverse Effects

A total of 94 immunization treatments were administered to all patients. There was no dose limiting toxicity and no serious adverse events that resulted in treatment discontinuation at any vaccine dose level. The most common toxicity (Table 3) was a self-limited, injection site reaction. Other reactions that occurred at a low frequency include fever, flu-like symptoms, anorexia, chills, nausea, and headache. These symptoms were also self-limiting and did not require intervention other than symptomatic measures such as acetaminophen.

Summary of Hematology, Chemistry, and ANA Values Pre and Post Treatment

Biological effects of ETBX-011 injections were monitored by recording blood hematology, chemistry, and anti-nuclear antibody (ANA) values of individual patients in case record forms (CRFs). Of 34 total patients entered into the trial, 28 received all three treatments with ETBX-011. For the 28 patients which received all three treatments, the blood hematology, chemistry, and ANA values at week 0 (prior to first treatment) were compared with those obtained at week 9 (three weeks after the third treatment). As shown in Table 4 below, there were no significant changes in chemistry or ANA values after treatments with ETBX-011. There was only one significant change in the blood hematology values. The basophil count was significantly (P=0.0403) lower at week 9 after treatments. However, this value remained in the normal range for basophil counts and, overall, there appeared to be no significant biological effects.

Clinical Outcomes

CEA levels at baseline and week 9 were assessed in patients. Among those with CEA levels available at baseline and follow-up, three (patients 010, 020, and 024) had no increase in CEA levels at the end of the immunization period while the remaining patients showed increased CEA levels. There were three patients with stable disease who remained so during the 9 week study period. All other patients experienced some level of progressive disease (Table 2). Of the seven patients in cohorts 1 and 2, there were five deaths and two patients remained alive at 12 months following the initiation of immunization. Of the 21 patients in cohort 3 and phase II, there were 10 deaths and all the remaining 11 patients were alive at 12 months, respectively. Of the six patients in cohort 5, there were three deaths and three patients were alive at 6, 7, and 8 months, respectively.

Of the 34 patients enrolled into the study, two patients received one treatment, four patients received two immunization treatments, and the remaining 28 patients received all three immunization treatments. All patients were followed for survival and Kaplan-Meier plots and survival proportions performed (PRISM software). Patient deaths were determined by information gathered from the social security death index (SSDI) database and clinical charts.

The seven patients in cohorts 1 and 2 experienced a 12-month survival proportion of 29% (FIG. 12A). Of the patients in cohorts 1 and 2, patient 004 survived 11 months and received additional post-immunization treatments with bevacizumab, folfox, and xeloda. Patient 003 survived nine months and received irradiation treatment after ETBX-011 immunizations. Patient 005, alive at 12+ months, received irradiation treatment and entered another clinical trial after immunizations. Patient 010 survived up to 12 months and entered two clinical trials after immunizations. Patients 002, 007, and 008 received no further treatments after immunizations and survived 3, 1, and 12+ months, respectively.

The 21 patients in cohort 3 and phase II experienced a 12-month survival proportion of 48% (FIG. 12B). Of the patients in cohort 3 and phase II, one patient (017) received concurrent cetuximab during immunizations. Patients 020 and 021 received concurrent bevacizumab during immunizations. Patient 011 surviving over 12 months received radiation treatment after ETBX-011 immunizations. Patients 012 and 016 survived over 12 months and 6 months, respectively, and received additional chemotherapy treatment after immunizations. Patient 013 survived 4 months and received treatment with nexavar after immunizations. Patient 015 survived 10 months and received follow-on treatment with cetuximab. Patient 019 survived over 12 months and received treatment with bevacizumab and xeliri after protocol immunizations. Patient 020 survived over 12 months and received treatment with bevacizumab after immunizations. Patient 021 survived over 12 months and received follow-on treatment with bevacizumab and xeloda. Patient 500 survived over 12 months and received treatment with cetuximab and xeloda and entered a clinical trial after immunizations. Patient 501 survived over 12 months and received treatment with cetuximab and irinotecan after ETBX-011 immunizations. Patient 508 has survived over 12 months; however, we have been unable to obtain further data on the characteristics of this patient. Patients 017, 023, 024, 025, 026, 502, 504, 506, and 507 received no further treatment after immunizations and survived 3, 4, 12+, 7, 4, 3, 12+, 3, and 12+ months, respectively (+ means still alive at the time of writing).

The six patients in cohort 5 experienced a 12-month survival proportion of 50% (FIG. 12C). Of the patients in this cohort, one patient (030) is currently alive at 8 months and received treatment with pazopanib and threshold 302 chemotherapy after ETBX-011 immunizations. Patient 031 is currently alive at 7 months and has not received further treatment after immunizations. Patient 032 received concurrent panitumumab, survived 6 months, and received treatment with folfox after immunizations. Patient 033 received concurrent panitumumab, survived 5 months with no additional therapy after immunizations. Patient 034 is currently alive at 6+ months and received radiation and treatment with xeloda after immunizations. Patient 035 received two treatments and survived 2 months.

With a median survival of 7.4 months, all 34 patients as a group (cohorts 1, 2, 3/phase II, and cohort 5) experienced a 12-month survival proportion of 41% (FIG. 12D). Of the 34 patients entered in to the study, 28 patients received the three immunization treatments and experienced a 12-month survival proportion of 55% (FIG. 13A) with a median survival of 10.625 months. For the colorectal adenocarcinoma patients, 27 patients received the three immunization treatments and experienced a 12-month survival proportion of 53% (FIG. 13B) with a median survival of 10.00 months.

Evaluation of Immune Parameters in Treated Metastatic Colorectal Cancer Patients

A secondary objective was to evaluate CEA specific immune responses following immunization treatments with the product. As determined by ELISA, we observed no antibody activity directed against CEA. We assessed CMI responses in colorectal cancer patients treated in cohort 1, cohort 2, cohort 3/Phase II, and cohort 5. PBMCs were isolated prior to ETBX-011 treatment and after all treatments as well as three weeks following the last treatment from patients. CEA specific ELISpot assays were performed on PBMC as previously described (6) to determine the numbers of interferon gamma (IFN-γ) secreting lymphocytes after exposure to CEA peptides in vitro. We determined the highest CMI responses during immunizations, regardless of time point (weeks 3, 6, or 9) in the patients treated in cohort 1, cohort 2, cohort 3/Phase II, and cohort 5. As shown in FIG. 14, this analysis revealed a dose response to increasing levels of product. The highest CMI levels occurred in patients that received the highest dose of 5×10¹¹ VP (Cohort 5).

Determination of Induced CMI Responses to CEA.

ELISpot analysis was performed on cryopreserved PBMC samples drawn before each immunization and after completion of the final immunization to assess CEA-specific CMI responses. We observed a dose response effect with the highest magnitude CEA-specific CMI responses occurring in patients who received the highest dose of Ad5 [E1-, E2b-]-CEA(6D) (FIG. 14). Of the doses received, 0/3 (0%) patients in cohort 1 exhibited positive CEA-directed CMI responses, 1/4 (25%) patients in cohort 2 exhibited positive CEA-directed CMI responses, 10/19 (53%) patients in cohort 3/phase II exhibited positive CEA-directed CMI responses, and 4/6 (67%) patients in cohort 5 exhibited positive CEA-directed CMI responses. The time course of induction of CEA-specific CMI (FIG. 15) demonstrated that there may be plateau in the magnitude of CEA CMI prior to the last dose. In the largest group of patients who received the same dose (cohort 3 plus phase II), we observed a significant increase over baseline in the average CEA-directed CMI responses at the 6 week evaluation (P<0.05, Mann-Whitney test), averaging 94 SFC/106 PBMC, which increased further by the 9 week evaluation (FIG. 15). One patient (patient ID 13) had a highly elevated baseline CEA-specific immune response (1100 SFC) and had elevated CMI at week six (2305 SFC) but did not return for 9-week evaluation and therefore, was not included in CEA CMI data analysis.

We also measured Ad5 NAb and CMI against Ad5 and correlated it with CEA-specific CMI. Each patient had their serum and PBMC sample tested at baseline (prior to treatment) and at 9 weeks after completion of 3 treatments. Nineteen of 31 colorectal cancer patients (61%) tested in this study had Ad5 neutralizing activity in serum samples prior to the onset of treatment with ETBX-011. The mean pre-treatment Ad5 NAb titer value obtained among all patients was 1:189±1:71 SEM (geometric mean 1:21) and the mean pre-treatment Ad5 NAb titer among seropositive patients was 1:308±1:108 (geometric mean 1:146). Analysis of serum samples from patients who received 3 immunizations revealed Ad5 NAb titers that were significantly increased (P<0.0001, Mann-Whitney test) by week 9 (mean 1:4767±1:1225 SEM (geometric mean 1:1541) when compared with their respective baseline values (FIG. 16). Analysis of PBMC for CMI responses to Ad5 also revealed a significant increase (P<0.01, Mann-Whitney test) in Ad5 directed CMI responses after immunizations with ETBX-011 (FIG. 16).

Comparison of week 9 CEA-directed CMI responses from patients with low baseline pre-existing Ad5 immunity (Ad5 NAb≧200) verses those with high baseline Ad5 immunity (Ad5 NAb>200) revealed no significant difference in immune responses (P>0.4, Mann Whitney test) (FIG. 17). Further, when the highest CEA specific CMI responses were compared with pre-existing or vector induced Ad5 NAb activity, there was no correlation between levels of CEA CMI and Ad5 NAb activity (FIG. 17). These data indicate that immunizations with ETBX-011 were not only able to overcome self-tolerance, but were also able to induce CEA-specific immune responses in colorectal cancer patients despite the presence of pre-existing and/or immunization induced Ad5 immunity. Together these clinical trial data support the advancement to a Phase III clinical trial with overall survival as the primary endpoint

Discussion

Adenoviral vectors have significant potential for use as cancer therapeutic vaccines because of their propensity to induce robust adaptive immune responses specifically against transgene products in general. However, recombinant first generation Ad5 [E1-] vectors used in homologous prime/boost regimens have been greatly limited in their potential efficacy due to the presence of pre-existing Ad5 immunity as well as vector induced immunity. Specifically, Ad5-directed immunity mitigates immune responses to TAA that have been incorporated into earlier generation Ad5 [E1-] based platforms. The Ad5 [E1-, E2b-] platform utilized in the present study was intended to accommodate a homologous prime-boost regimen, by avoiding presentation of antigens that are the targets of pre-existing Ad5 immunity. Since CEA has been identified as one of the priority cancer antigens by the National Cancer Institute, we investigated this TAA as a transgene to be incorporated into the new Ad5 [E1-, E2b-] vector platform for use as a cancer therapeutic vaccine. CEA expression in adults is normally limited to low levels in the gastrointestinal epithelium, whereas, CEA is over-expressed in adenocarcinomas of the colon and rectum and in many breast, lung, and pancreas cancers. We chose the HLA A2 restricted CAP1(6D) modification of CEA because, compared with the wild type CAP1 epitope, CAP1(6D) can enhance the sensitization of CTLs and has been included in our recent CEA-based vaccine constructs. Although we did not test for HLA type because we used full length CEA that is not HLA-restricted, A*0201 is the allele observed most frequently in Caucasians (allele frequency 0.2717) and is common in other populations. However, it is possible to test patients for HLA type and utilize the relationship between HLA type and clinical and/or CMI responses.

Previously, we tested multiple subcutaneous immunizations employing three administrations of a single dose level (1×10¹⁰ VP) of this class of Ad5 vaccine expressing the TAA CEA, (Ad5 [E1-, E2b-]-CEA(6D)) in a pre-clinical murine model of CEA expressing cancer. In mice with pre-existing Ad5 immunity, we demonstrated the induction of potent CEA directed CMI responses that resulted in anti-tumor activity and noted that these CMI and anti-tumor responses were significantly greater than those responses induced by a current generation Ad5 [E1-] based vector vaccine. We have also demonstrated in additional animal models (both cancer and infectious disease targeted) that multiple subcutaneous immunizations with vaccines based on the new Ad5 [E1-, E2b-] platform induce CMI responses that were superior to those of current generation Ad5 [E1-] based vaccines, can overcome the barrier of Ad5 immunity, and can be utilized in multiple immunization regimens requiring a generation of robust CMI responses. In our present report, the greatest magnitude of CEA-directed CMI responses occurred in patients receiving the highest dose of the vector. We observed that a CEA-directed CMI response was induced in a dose-responsive manner despite the presence of pre-existing and/or vector induced Ad5 immunity. No CEA directed antibody responses were observed either pre- or post-vaccination employing an ELISA technique. In a preliminary analysis (data not shown), we also observed a population of polyfunctional CD8+T cells (those that secrete more than one cytokine when activated) after immunizations, a sign of greater functionality of T cells induced by the vaccine. These data support the use of the Ad5 [E1, E2b-]-CEA(6D) vector in homologous prime-boost regimens designed to induce and increase CEA-directed CMI responses in patients with advanced colorectal adenocarcinoma, as well as any number of other vaccine amenable diseases or applications.

We believe there are factors that contribute to the favorable activity of this new platform. As compared to earlier generation Ad5 [E1-] vectors containing deletion in the early 1 (E1) gene region, the Ad5 [E1-, E2b-] vector platform with additional deletions in the early 2b (E2b) gene region exhibits significantly reduced inflammatory responses directed at the vector. This can result in longer transgene expression and a reduction in elimination of transgene expressing cells (e.g., antigen presenting cells) that would otherwise occur due to induced inflammatory responses. Since Ad5 late gene antigen expression is significantly reduced as compared to earlier generation Ad5 platforms, this could enable the Ad5 [E1-, E2b-] platform to evade Ad5 immune mediated neutralizing activity for significantly longer periods of time resulting in greater longevity and amplification of TAA expression. In addition, a E2b gene product, a polymerase, is a known target of human cellular memory immune responses to Ad5 infection and its elimination from the vaccine could be furthering its capability in the setting of pre-existing Ad5 immunity. Without being bound by theory, the extended and/or greater expression of TAA by the vector in this milieu could result in a more effective immune response against the target antigen. However, it is also possible that this vector configuration produces better transgene expression, different biodistribution, or different innate/adaptive immune effects that impact the effectiveness of this vector, rather than escape from pre-existing immunity.

Of interest is the observation that treated patients in our study exhibited favorable survival probability. Overall, all 25 patients treated at least 2 times with Ad5 [E1-, E2b-]-CEA(6D) exhibited a 12-month survival probability of 48% and this was achieved despite the presence of significant levels of pre-existing Ad5 neutralizing antibody titers.

In other clinical trials, immunotherapeutic agents have been found to increase overall survival without having a direct impact on time to objective disease progression, a trend noted in our study as well. Without being bound by theory, by engaging the patient's immune system, active immunotherapeutics, such as Ad5 [E1-, E2b-]-CEA(6D), could induce continuous immunologic anti-tumor responses over a long period of time that could result in a “deceleration” or alteration in specific aspects of the rapid growth rate or spread of the tumor not measured by standard response assessments. Indeed, we have observed slower tumor progression in Ad5 immune mice harboring established CEA-expressing tumors following treatment with Ad5 [E1-, E2b-]-CEA(6D). Moreover, it has been noted that overall survival might be the only true parameter for determination of clinical efficacy of any potential cancer (immune) therapy.

As with any new treatment modality, safety is an important factor. In this Phase I/II trial, we demonstrated that the Ad5 [E1-, E2b-]-CEA(6D) could be manufactured to scale, as well be easily and repeatedly administered by conventional subcutaneous injection techniques. The most common adverse effects were site of injection reactions and flu-like symptoms consisting of fever, chills, headache, and nausea. There was no impact on blood hematology or serum chemistries and, overall, the treatments were well tolerated. Specifically, no SAE were noted, and no treatments were stopped due to adverse events, indicating that a dose limitation to use of Ad5 [E1-, E2b-]-CEA(6D) in this clinical application had not been met.

These data suggest that patients with advanced colorectal cancer which are treated with Ad5 [E1-, E2b-]-CEA(6D) do not have serious adverse effects and may experience extension of life even if they have pre-existing immunity to Ad5. The results of this trial are encouraging enough to advance to a large, randomized, single agent trial. The observation that some of the patients experienced an increase of CMI which is dose dependent, could be an indication that this may play a role in their clinical outcome.

TABLE 3 Adverse Events % Incidence # Of Unrelated/ Probably/ *Grade (G1, (Based on 94 Adverse Events Events Unlikely Possible Definite G2, or G3) treatments) Injection Site Reaction 21 21 G1 (19): G2 (2) 22.3 Pain (all types) 17 17 G1 (8); G2 (7); 18.1 G3 (2) Fever 10 4 2 4 G1 (7); G2 (3) 10.6 Flu-like symptoms 10 3 5 2 G1 (9); G2 (1) 10.6 Fatigue 8 6 2 G1 (5); G2 (2); 8.5 G3 (1) Shortness of Breath 6 6 G1 (3); G2 (3) 6.4 Anorexia 5 4 1 G1 (3); G2 (2) 5.3 Chills 5 1 1 3 G1 (5) 5.3 Nausea 5 4 1 G1 (5) 5.3 Constipation 5 5 G1 (3); G2 (2) 5.3 Edema 5 5 G1 (3); G2 (2) 5.3 Vomiting 4 4 G1 (4) 4.3 Hypertension 3 3 G1 (2); G2 (1) 3.2 Anemia 3 3 G1 (1); G2 (1); 3.2 G3 (1) Cough 2 2 G1 (2) 2.1 Depression 2 2 G1 (2) 2.1 Diarrhea 2 2 G1 (2) 2.1 Headache 2 1 1 G1 (2) 2.1 Hypoalbuminemia 2 2 G1 (1); G2 (1) 2.1 Hypokalemia 2 2 G1 (1); G2 (1) 2.1 Pleural Effusion 2 2 G2 (1); G3 (1) 2.1 Alkaline Phosphatase Increase 2 2 G1 (1); G3 (1) 2.1 Myalgia 2 2 G1 (2) 2.1 Night Sweats 2 2 G1 (1); G2 (1) 2.1 Sleep 2 2 G1 (2) 2.1 Low Magnesium 2 2 G1 (2) 2.1 Abdominal Bloating 1 1 G1 (1) 1.1 Abdominal Distention 1 1 G3 (1) 1.1 Abdominal Swelling 1 1 G2 (1) 1.1 Abdominal Wound 1 1 G2 (1) 1.1 ALT Increase 1 1 G1 (1) 1.1 AST Increase 1 1 G2 (1) 1.1 Biliary Obstruction 1 1 G3 (1) 1.1 Bowel Obstruction 1 1 G3 (1) 1.1 Cold 1 1 G1 (1) 1.1 Dyspnea 1 1 G3 (1) 1.1 Dysuria 1 1 G1 (1) 1.1 Frequent Urination 1 1 G1 (1) 1.1 GI Disorder 1 1 G3 (1) 1.1 Extra Pyramidial Movements 1 1 G1 (1) 1.1 Insomnia 1 1 G1 (1) 1.1 Herpes Simplex 1 1 G1 (1) 1.1 Hypotension 1 1 G1 (1) 1.1 Loss of Appetite 1 1 G1 (1) 1.1 Low White Blood Cells 1 1 G1 (1) 1.1 Numbness/Sensation in Fingertips 1 1 G1 (1) 1.1 Onset of Menses 1 1 G1 (1) 1.1 Poor Quality Sleep 1 1 G1 (1) 1.1 Presyncope 1 1 G2 (1) 1.1 Pruritis 1 1 G1 (1) 1.1 Rash-Right Lower Eye Lid 1 1 G1 (1) 1.1 Red/Swelling Right Upper Eyelid 1 1 G1 (1) 1.1 Renal Calculi 1 1 G2 (1) 1.1 Runny Nose 1 1 G1 (1) 1.1 Shallow Breathing 1 1 G1 (1) 1.1 Skin Rash 1 1 G1 (1) 1.1 Vaginal Discharge 1 1 G1 (1) 1.1 Concentration 1 G1 (1) 1.1 Weight Loss 1 1 G2 (1) 1.1 Arthritis Joint Inflammation 1 1 G1 (1) 1.1 Flushing 1 1 G1 (1) 1.1 Acute Renal Failure Disease G3 (1) 1.1 progression *Parenthesis ( ) indicates numbers of events.

TABLE 4 Hematology, Chemistry, and ANA values Week 0 value Week 9 value (Mean ± SEM) (Mean ± SEM) Hematology Test Hgb (g/dL) 13.09 ± 0.313 12.48 ± 0.413 Hct (%) 39.63 ± 0.875 37.92 ± 1.140 Plts (×109/L) 225.1 ± 20.76 247.3 ± 23.57 WBC (×103/mm3)  6.81 ± 0.532  8.21 ± 0.741 Neutrophils (%) 64.46 ± 2.068 67.28 ± 3.268 Lymphocytes (%) 23.23 ± 1.874 18.34 ± 2.071 Monocytes (%)  8.86 ± 0.462  7.68 ± 0.569 Eosinophils (%)  3.97 ± 0.677  3.16 ± 0.685 Basophils (%)  0.52 ± 0.056  0.38 ± 0.048 Chemistry Test Na (mEq/L) 139.2 ± 0.424 137.9 ± 0.718 K (mEq/L)  3.90 ± 0.085  3.80 ± 0.073 Cl (mEq/L) 105.0 ± 0.561 103.3 ± 1.061 CO2 (mEq/L)  27.8 ± 0.374 27.63 ± 0.458 BUN (mg/dL)  17.0 ± 1.136  17.1 ± 1.611 Creatinine (mg/dL)  0.81 ± 0.046  0.86 ± 0.054 Glucose (mg/dL) 121.8 ± 7.458 123.5 ± 7.885 Ca (mg/dL)  8.84 ± 0.075  8.87 ± 0.073 Total protein (g/dL)  6.95 ± 0.078  6.67 ± 0.100 Albumin (g/dL)  3.78 ± 0.085  3.62 ± 0.113 AST (U/L) 31.71 ± 3.846 31.88 ± 3.506 ALT (U/L) 27.83 ± 4.228 25.67 ± 3.414 Alkaline phosphatase (U/L) 107.0 ± 13.30 124.0 ± 17.40 Bilirubin (mg/dL)  0.78 ± 0.071  0.75 ± 0.079 *ANA Test Titer 103.3 ± 51.04 123.3 ± 50.56 *Values represent inverse of the titer and are from patients with positive values.

The various embodiments described above can be combined to provide further embodiments. All of the U.S. patents, U.S. patent application publications, U.S. patent application, foreign patents, foreign patent application and non-patent publications referred to in this specification and/or listed in the Application Data Sheet are incorporated herein by reference, in their entirety to the same extent as if each individual publication, patent, or patent application was specifically and individually indicated to be incorporated by reference.

Aspects of the embodiments can be modified, if necessary to employ concepts of the various patents, application and publications to provide yet further embodiments.

These and other changes can be made to the embodiments in light of the above-detailed description. In general, in the following claims, the terms used should not be construed to limit the claims to the specific embodiments disclosed in the specification and the claims, but should be construed to include all possible embodiments along with the full scope of equivalents to which such claims are entitled. Accordingly, the claims are not limited by the disclosure. 

What is claimed is:
 1. A method of treating a carcinoembryonic antigen (CEA)-expressing cancer in a human in need thereof, the method comprising: administering to the human a single dose of a pharmaceutical composition comprising from 1×10⁹ to 5×10¹¹ viral particles of a replication-defective vector comprising a nucleic acid sequence encoding a modified carcinoembryonic antigen (CEA) comprising a sequence set forth in SEQ ID NO:5 (YLSGADLNL).
 2. The method of claim 1, wherein the human has tumor cells that overexpress CEA as compared with a baseline level in a non-tumor cell.
 3. The method of claim 1, wherein the human has pre-existing immunity to Ad5.
 4. The method of claim 1, wherein the human has cancer of the colon, rectum, breast, lung, pancreas, thyroid, prostate, or a combination thereof.
 5. The method of claim 1, wherein the replication-defective vector is a replication-defective adenoviral vector.
 6. The method of claim 5, wherein the replication-defective adenoviral vector has a deletion in an early 2b (E2b) gene region.
 7. The method of claim 6, wherein the replication-defective adenoviral vector further comprises a deletion in an early 1 (E1) gene region, a deletion in an early 3 (E3) gene region, a deletion in an early 4 (E4) gene region, or a combination thereof.
 8. The method of claim 1, wherein the replication-defective vector comprises a nucleic acid sequence with at least 80% identity to a region in SEQ ID NO: 3 from 1057 to
 3165. 9. The method of claim 1, wherein the pharmaceutical composition comprises a dose of at least 10⁹ replication-defective viral particles.
 10. The method of claim 1, wherein the pharmaceutical composition comprises a dose of at least 10¹¹ replication-defective viral particles.
 11. The method of claim 1, wherein the administering is subcutaneous administration.
 12. The method of claim 1, wherein the administering is intradermal, parenteral, intravenous, intramuscular or intraperitoneal administration.
 13. The method of claim 1, wherein the human has previously been determined to overexpress CEA in tumor cells as compared with a baseline level in a non-tumor cell.
 14. The method of claim 1, further comprising irradiating the human or administering a chemotherapy to the human.
 15. The method of claim 1, wherein the pharmaceutical composition is administered to the human at least two times.
 16. The method of claim 1, wherein the pharmaceutical composition is administered to the human at an interval of at least two to four weeks or at least three months.
 17. The method of claim 1, wherein the pharmaceutical composition is first administered to the human at an interval of at least two to four weeks followed by a subsequent administration of the pharmaceutical composition at an interval of at least three months.
 18. The method of claim 1, wherein the pharmaceutical composition further comprises an immune adjuvant.
 19. The method of claim 1, further comprising administering to the human a chemotherapy concurrently with or subsequently after administering the pharmaceutical composition.
 20. The method of claim 19, wherein the chemotherapy is selected from the group consisting of FOLFOX, pazopanib, sorafenib, oxaliplatin, bevacizunab, Capecitabine, fluoropyrimidine, irinotecan, Mitomycin, Regorafenib, cetuxinab, panitumumab, acetinophen, and a combination thereof.
 21. The method of claim 1, wherein the pharmaceutical composition further comprises a vector encoding an antigen selected from the group consisting of p53, HPV E6, HPV E7, MAGE-A1, MAGE-A2, MAGE-A3, MAGE-A4, MAGE-A6, MAGE-A10, MAGE-A12, BAGE, DAM-6, -10, GAGE-1, -2, -8, GAGE-3, -4, -5, -6, -7B, NA88-A, NY-ESO-1, MART-1, MC1R, Gp100, PSA, PSM, Tyrosinase, TRP-1, TRP-2, ART-4, CAMEL, Cyp-B, Her2/neu, hTERT, hTRT, iCE, MUC1, MUC2, PRAME, P15, RU1, RU2, SART-1, SART-3, WT1, AFP, 13-catenin/m, Caspase-8/m, CEA, CDK-4/m, ELF2M, GnT-V, G250, HSP70-2M, HST-2, KIAA0205, MUM-1, MUM-2, MUM-3, Myosin/m, RAGE, SART-2, TRP-2/INT2, 707-AP, Annexin II, CDC27/m, TPI/mber-abl, ETV6/AML, LDLR/FUT, Pml/RARa, and TEL/AML1, and a combination thereof.
 22. The method of claim 1, wherein the pharmaceutical composition further comprises a vector encoding an antigen selected from the group consisting of HPV E6, HPV E7, Her2/neu, MUC1, PSA, PSM, or a combination thereof. 